Help with Gyn Dx Coding

Kdailey

Networker
Messages
42
Location
Seacoast-Dover NH
Best answers
0
I am new to pathology and gyn coding and need some assistance with a particular scenario I am finding frequently.

I have a path report and the clinical requisition from the physician who ordered the test (such as 87621 and 88142). I have been instructed to code for any final diagnosis found on the path report and to also use the clinical diagnosis codes the physician listed on the requisition.

My problem is this: the final diagnosis on the path report will state negative for high risk HPV.
The clinical diagnosis codes the physician entered on the requisition are V72.31 and 079.4 (HPV).

Is it okay to submit the claim with V72.31, 079.4 even though the path report states negative for high risk HPV? Are there more types than just the high risk, so 079.4 could still be accurate?
 

pcordill

Contributor
Messages
10
Location
Long Beach, CA
Best answers
0
If the requistion provided 079.4, there is no reason for your to question the diagnosis even though the results of the HPV testing came out negative. There are most certainly many types of HPV.

Bottom line, if it's documented you can use the ICD-9 provided.
 

mcpalmeter

Guru
Local Chapter Officer
Messages
192
Location
Jacksonville, Florida - 90417
Best answers
0
Pathology performed to confirm diagnosis. Looks like physician was trying to rule out HPV and added it as an ordering dx. Big no-no. He should have reported the signs/symptoms which led him to suspect HPV. Per pathology report patient does NOT have HPV. Do not code this diagnosis and have this diagnosis attached to the patient inappropriately. If report is negative, revert to signs/symptoms for ordering the test.
 

Kdailey

Networker
Messages
42
Location
Seacoast-Dover NH
Best answers
0
Pathology performed to confirm diagnosis. Looks like physician was trying to rule out HPV and added it as an ordering dx. Big no-no. He should have reported the signs/symptoms which led him to suspect HPV. Per pathology report patient does NOT have HPV. Do not code this diagnosis and have this diagnosis attached to the patient inappropriately. If report is negative, revert to signs/symptoms for ordering the test.
I do not have any signs or symptoms. I only have the physician diagnosis of V72.31, 079.4 and the path report that states " final diagnosis cervical/endocervical pap smear: satisfactory for evaluation, endocervical component present. Negative for intraepithelial lesion or malignancy. Negative for high risk HPV."

The claims are being billed to Medicare and I fear having the claim denied as patient responsibility if I only bill with the V72.31. I work for a 3rd party billing company and the client is extremely upset if a patient gets a bill. Management in my office is scrutinizing coding (though none of them are certified coders).

If I shouldn't be including the 079.4 on the claim I need to have some hard facts as to why I chose not to use that code that the doctor wrote on the requisition. I'm just trying to be completely clear on the action I take so I can defend my position to the powers that be.
 

treinemer

Networker
Messages
32
Best answers
0
I do not have any signs or symptoms. I only have the physician diagnosis of V72.31, 079.4 and the path report that states " final diagnosis cervical/endocervical pap smear: satisfactory for evaluation, endocervical component present. Negative for intraepithelial lesion or malignancy. Negative for high risk HPV."

The claims are being billed to Medicare and I fear having the claim denied as patient responsibility if I only bill with the V72.31. I work for a 3rd party billing company and the client is extremely upset if a patient gets a bill. Management in my office is scrutinizing coding (though none of them are certified coders).

If I shouldn't be including the 079.4 on the claim I need to have some hard facts as to why I chose not to use that code that the doctor wrote on the requisition. I'm just trying to be completely clear on the action I take so I can defend my position to the powers that be.

I am assuming in my response below that the HPV was ordered with a pap.

It's my understanding (and I learned this from our other long term coders here in our pathology office) that the pap (88175, 88164, 88142) and the Physician Interp (88141) require an ordering diagnosis as primary diagnosis with the results of the pap as the secondary dx.

The HPV test does not require an ordering dx unless it is normal (not detected). For the HPV we do not use the 079.4, we use V73.81 screening HPV, if the pap was normal and the HPV was not detected. On a cervical pap if it was abnormal (i.e. ASCUS 795.01) then 795.01 would be the only diagnosis on the HPV. If High risk HPV was detected then the only dx would be 795.05.

That being said...Medicare will deny non detected HPV tests with normal paps and put it to CO-45, patient responsibility. Nothing you can do about that. They will pay if it is abnormal or was run as a reflex to an abnormal pap but not if everything is normal. Were finding more insurances are going to this as well because Medicare does. If they do cover it they will put it to deductible and yes, we get a patient call upset and asking us to change the code because the insurance said we coded it wrong... NOT.

Even more frustrating is with the new guidelines of paps being run every 3 years along with an HPV I am seeing an increase in HPV's being run, and along come the denials along with that and the patient calls...


Hope this makes sense and helps answer your question.
 

Bready

Guru
Messages
155
Best answers
1
I believe the appropriate codes would be V72.31 and V73.81. I do not know if Medicare will pay for these codes but it might be worth looking at.

I agree that you should not give the patient HPV if she does not have it and that you should code from the path report findings. To do otherwise might be construed as fraudulent because you are coding in order to be paid. This is what you should tell your supervisor. You are concerned for the company which could be held liable if Medicare decides to do an audit. It is hard to be in your position. Good luck.
 
Top