Pathology/Lab Coding Alert

New cervical ICD9 Codes mean more specific diagnoses for coders and perhaps more money for pathologists. The annual ICD-9 update (effective Oct. 1 with a grace period through Dec. 31) details new codes for reporting nonspecific abnormal Pap smears, and may open the door for additional test coverage.

New code 795.09 (Other nonspecific abnormal Papanicolaou smear of cervix) could impact Medicare and other insurance payments because the words "unsatisfactory smear" were added to the description, says Dennis Padget, CPA, FHFMA, president of Padget & Associates, a pathology compliance-consulting firm in Simpsonville, Ky. "Historically, labs have not classified unsatisfactory smears as either normal or abnormal," he says. When labs get an unsatisfactory Pap test, they often use the diagnosis the referring physician submitted usually a V code, such as V76.2 (Routine cervical Papanicolaou smear), he adds. But if "unsatisfactory" is now to be classified as abnormal using code 795.09, Medicare and other insurers may cover both a pathologist's evaluation of the smear and more frequent follow-up testing because the patient now has a "history of abnormal Pap," Padget says. That is, if CMS doesn't change anything in the interim, he cautions. Be alert for payment policy clarifications that counteract the increased payments that would be a natural consequence of this ICD-9 code change. Abnormal Pap Means Additional Procedure Coverage Whether the initial Pap is ordered for screening or diagnostic purposes, if the cytotechnician reviews the smear and finds it abnormal, Medicare and other insurers cover a pathologist's interpretation service. Since 795.09 includes "unsatisfactory smear" as abnormal, payers may be covering more interpretations. And because Medicare considers a previous abnormal Pap as cause for more frequent testing, it may be covering more Pap smears as well, Padget says. "Educate lab staff and referring physicians about the implications of this change on Pap coverage, coding and payment, but be cautious until we know for sure that the payment policy implications have been approved," he stresses. Here are the steps to code for 1) the original Pap test, 2) the interpretation of an abnormal smear, and 3) follow-up Pap smears:

1. Assign the Pap smear procedure code based on the initial reason for the test, regardless of the results. For screening Pap smears of asymptomatic patients, report one of the HCPCS Level II codes (P3000, Screening Papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision; or G0123 or G0143-G0148, Screening cytopathology, cervical or vaginal ) depending on the method used. When performing a diagnostic Pap smear for a patient with signs or symptoms of disease, use 88142-88154, Cytopathology, cervical or vaginal ; or 88164-88167, Cytopathology, slides, cervical or vaginal. If the Pap [...]