Pathology/Lab Coding Alert

At last you can tell the truth when billing Medicare for posthysterectomy screening Pap smears. As of Oct. 1, Medicare will accept two new low-risk diagnosis codes so that you no longer have to report a screening for "cervix" when the patient doesnt have one.

Before CMS announced the change, you could report screening Pap smears to Medicare with only one of two diagnosis codes V76.2 (Special screening for malignant neoplasms, cervix) for low-risk patients, or V15.89 (Other specified personal history presenting hazards to health, other) for high-risk patients. Medicare will begin to accept V76.47 (Special screening for malignant neoplasms, vagina) and V76.49 (Special screening for malignant neoplasms, other sites) for low-risk patients, according to program memorandum AB-03-054. You can access the announcement on the Internet at http://www.cms.gov/manuals/pm_trans/AB03054.pdf. Differentiate Between Screening and Diagnostic Physicians order screening Pap smears in the absence of signs or symptoms of disease. "If the patient presents with symptoms or a personal history indicating a diagnostic purpose for the test, the Pap smear is not a screening," says Melanie Witt, RN, CPC, MA, an independent coding educator based in Fredericksburg, Va. You should not report the service with one of the screening diagnosis codes, but with the most specific ICD-9 code available to describe the symptoms or condition. Medicare accepts a host of diagnosis codes to indicate medical necessity for a diagnostic Pap smear. When the patient has no signs or symptoms, however, Medicare has accepted only V76.2 or V15.89 until now. "Medicares addition of V76.47 and V76.49 is a good thing," Witt says. "It has always been frustrating that although ICD-9 provided other V codes that might accurately describe a patients condition, Medicare declared that it would only pay for screening Pap smears reported with two specific codes." Screening Coverage Rules Vary by Risk Level To decide which diagnosis code to report for screening Pap smears, you must first determine the patients risk level. Based on whether the patient is at high or low risk for developing cervical cancer, Medicare has established different frequency limitations for screening Pap smears. Medicare covers Pap screening for low-risk patients once every two years, and high-risk patients once a year. Medicare considers patients who have any of the following documented risk factors to be high-risk: early onset of sexual activity, multiple sexual partners, history of sexually transmitted disease, fewer than three negative Pap smears within the previous seven years, and daughters of women who took DES (diethylstilbestrol) during pregnancy. Diagnosis V15.89 is the only code Medicare accepts for screening Pap smears performed annually for high-risk patients, but you may add a second code for the condition that meets one of the above criteria as well. Medicare Adds Options [...]