Pathology/Lab Coding Alert

Question: Which diagnosis code should we use to report ASCUS Pap smear results under the new Bethesda reporting system? The new ICD-9 codes distinguish between ASCUS "favor benign" and "favor dysplasia," but Bethesda dropped that wording soon after the new ICD-9 codes came out. We used to report ASCUS as 795.0, but now we need to code to the fifth digit and we don't know which code to use. Kentucky Subscriber Answer: You are correct that the 2003 ICD-9 manual added new five-digit codes that subdivided old code 795.0 (Nonspecific abnormal Papanicolaou smear of cervix). In addition to nonspecific and unspecified codes, the new ICD-9 listings divided atypical squamous cell changes of undetermined significance (ASCUS) into the categories of "favor benign" and "favor dysplasia." The 2003 codes are as follows: 795.00 Nonspecific abnormal Papanicolaou smear of cervix, unspecified 795.01 Atypical squamous cell changes of undetermined significance favor benign (ASCUS favor benign) 795.02 Atypical squamous cell changes of undetermined significance favor dysplasia (ASCUS favor dysplasia) 795.09 Other nonspecific abnormal Papanicolaou smear of cervix. Soon after these codes came out, Bethesda issued new cervical cytology classification guidelines that no longer use the terms "favor reactive" and "favor squamous intraepithelial lesion (SIL)" nomenclature. Rather, the new Bethesda system divides the ASC category into ASCUS and ASC-H (ASC cannot exclude high-grade SIL). "There is no perfect match for ASCUS between the current Bethesda system and the 2003 ICD-9 codes, but 795.01 is the best code to describe both ASCUS and ASC-H findings under the new code structure," says Melanie Witt, RN, CPC, MA, an independent coding educator based in Fredericksburg, Va. "You would not want to assign ASC-H to 795.02, which would imply a potentially more severe condition." Nor should you report ASCUS or ASC-H findings as unspecified (795.00, Nonspecific abnormal Papanicolaou smear of cervix, unspecified) or nonspecific (795.09, Other nonspecific abnormal Papanicolaou smear of cervix) because the findings are specified, and they are specific.