Pathology/Lab Coding Alert

Less than a year after implementation of a Medicare ruling that promised to solve a long-standing coding dilemma regarding diagnosis coding for post-hysterectomy Pap smears, resolution seems farther away than ever. The problem was Medicare's acceptance of only a cervical diagnosis code for low-risk screening Pap smears, even if the patient had a hysterectomy. The solution was Medicare's introduction of a noncervical code as a payable diagnosis for low-risk patients. Now, after months of denials from various Medicare carriers for the new code for post-hysterectomy screening Pap smears, coders once again need to rethink the way they report these services. Medicare Specifies Diagnosis Codes for Screening Pap Smears By definition, a screening Pap smear is ordered in the absence of signs or symptoms of a disease. "If the patient presents with symptoms or a personal history that indicates a diagnostic purpose for the test, the Pap is not considered screening," explains Melanie Witt, RN, CPC, MA, an independent coding educator based in Fredericksburg, Va. In those cases, there are a host of diagnosis codes that indicate medical necessity for the test, according to Medicare. However, in the absence of signs and symptoms, Medicare historically has indicated that only two diagnosis codes were acceptable to indicate medical necessity for a screening Pap smear. "Although ICD-9 provides other V codes that might accurately describe a patient's condition and the reason for the screening Pap, Medicare declared that only two of those codes would result in reimbursement when reported on item 24E of the HCFA-1500 claim form," Witt says. Those codes were ICD9 V76.2 (Special screening for malignant neoplasms, cervix) and V15.89 (Other specified personal history presenting hazards to health).

These two codes indicate whether the patient is at high or low risk for developing cervical cancer. Medicare established different frequency limitations for screening Pap smears based on the risk-level distinction. Low-risk patients are identified by V76.2 and are covered for a screening Pap smear once every two years. High-risk patients are identified by V15.89 and are covered once a year. Patients who have any of the following documented risk factors are considered 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. Medicare adds that a woman whom the physician documents as being of childbearing age can be eligible for this screening benefit every year if she has or has had cervical or vaginal cancer. Any problem within the preceding three years that would put her at risk for developing cervical or vaginal cancer also qualifies her for a screening.

"The dilemma created by these Medicare coding [...]