Wiki Pap test coding


Swartz Creek, MI
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I have a question, I am reviewing PAPS coding in the lab. It is my understanding that the referring physician must provide ICD9 codes. V76.2, v73.21 are appropriate ICD9 and we are getting paid. However, I noticed that on one claim the ref. phys assigned 726.71, bursitis and we were paid. It seems like the insurance would deny this claim because of the wrong ICD9. It is my understanding that we must use the code provided by the referring physician. Any thoughts appreciated.
I code paps for a pathology lab and it's my understanding that the V73.21 is a clinic code, not a lab code.

We do have to bill with the ordering dx (reason for pap). If there is a question such as the 726.71 or other non gyn related dx then you would need to contact the clinic and find out the reason for the pap. We have a fax we use that asks if it was screening routine (V76.2 or V76.47 if vaginal), screening high risk (with dx code), or diagnostic (with dx code) and a physicians signature. They usually fax them back with the correct ICD-9 then.

You do need to be careful when requesting ordering ICD-9's from clinics though. We can not direct them on how to code the ordering diagnosis on a pap or lead them to a diagnosis just to get the claim paid as that is fraud.