Pathology/Lab Coding Alert

Distinguish diagnostic, high-risk, low-risk. Knowing the frequency coverage rules for screening Pap smears is all well and good -- but do you know how to legitimately "break" the rules for inadequate specimens and still get paid for the lab tests? When your lab processes "repeat" Pap tests following an inadequate or abnormal Pap, you'll need to know the diagnosis and procedure coding tricks to make sure you get your claims paid. Show Medical Necessity for Repeat Following Abnormal Pap When a patient's cervical Pap smear returns abnormal results, you should report 795.0x (Abnormal Papanicolaou smear of cervix and cervical HPV). This code series requires a fifth digit, and if you don't include it, this "could be a reason for a denial," says Peggy Stilley, CPC, COBGC, ACS-OB, director of auditing services at the American Academy of Professional Coders. Select one of the following codes to show medical necessity when the physician [...]