V13.22

treinemer

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We routinely get paps with an incoming dx of V13.22 Personal history of Cervical Displasia. Pts have previous dx of 795.00-04 that were paid but the V13.22 are being denied as not medically necessary.

So far Medicare, Premera, and United Health Care are denying these codes. Just checking if this is something new, or if someone is aware of guideline changes that I have not seen???

As an asside we are also seeing denials now from many carriers for the CT/NG (87491/87591) unless they are positive results. Frustrating because you can't see if they are positive without testing but the patient has to pay if it's a neg result.

Patients are not amused in any case :rolleyes:
 

treinemer

Networker
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if it is a follow up from a previous abnormal PAP there is a V72.3x code for that
Sorry...I should have said that I am a pathology lab coder.-The V72.3x would be for the clinical exam but won't work for the testing of the specimen. Sad part is it most likely would have paid if they had used the original dx of 795.0X but using a V code for personal hx of is getting it denied as not medically necc.

This seems to be a recent problem, like in the last month or so.
 
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