Pathology/Lab Coding Alert

Question: When our clients order a screening HPV test using the appropriate screening ICD-9 code, V73.89, we-re getting denials. What could be the problem?

New Hampshire Subscriber

Answer: The code you mention, V73.89 (Special screening examination for viral and chlamydial diseases; other specified viral and chlamydial diseases; other specified viral diseases), was the appropriate ICD-9 code for an HPV screening prior to Oct. 1, 2007.

After that date, however, ICD-9 instituted a more specific code: V73.81 (Special screening examination for viral and chlamydial diseases; other specified viral and chlamydial diseases; human papillomavirus [HPV]). Your carrier probably updated the payment policy to recognize only the new code to show medical necessity for an HPV screen.

Don't miss: ICD-9 2008 also revised the specifications underneath V72.31 (Routine gynecological examination) to say, "Use additional code to identify: human papillomavirus (HPV) screening (V73.81), routine vaginal Papanicolaou smear (V76.47)."

What this means: If your clients order a screening Pap smear and HPV test using the code for the physician's routine gynecological exam (V72.31), you won't get paid for the lab work. The ordering physician must indicate V76.2 (Special screening for malignant neoplasms; cervix) to show medical necessity for the screening Pap test, and V73.81 to show medical necessity for the screening HPV test.

Be specific: Although ICD-9 has another code that might appear to cover HPV screening (V74.5, Special screening examination for bacterial and spirochetal diseases; venereal disease), a new text note clarifies that you should use the more specific V73.81 code. The "excludes" note following V74.5 says, "special screening for nonbacterial sexually transmitted diseases (V73.81-V73.89, V75.4, V75.8)."