Wiki Vaginal vs Cervical vs Vaginal/Cervical screening Pap smears with/without gyno exam

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Code: Z12.4
Encounter for screening for malignant neoplasm of cervix
Excludes 1: when screening is part of general gynecological examination (Z01.4-)
Excludes 2: encounter for screening for human papillomavirus (Z11.51)
Encounter for screening pap smear for malignant neoplasm of cervix
Parent Code Notes: Z12
Excludes1: encounter for diagnostic examination-code to sign or symptom
Use additional code to identify any family history of malignant neoplasm (Z80.-)

Block Notes
Persons encountering health services for examinations (Z00-Z13)
Note: Nonspecific abnormal findings disclosed at the time of these examinations are classified to categories R70-R94.
Excludes 1: examinations related to pregnancy and reproduction (Z30-Z36, Z39.-)

Coding Guidelines
Factors influencing health status and contact with health services (Z00-Z99)
Note: Z codes represent reasons for encounters. A corresponding procedure code must accompany a Z code if a procedure is performed. Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00-Y89 are recorded as 'diagnoses' or 'problems'. This can arise in two main ways:
(a) When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury.
(b) When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury.
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Hello,

Maybe one of you can help clarify these different scenarios for me? I work in a pathology lab, so we do not see patients at all, we are given the specimen and requisition form for testing from the physician.
We go off what is specified on the requisition form that accompanies the pap smear to determine where it was collected from. However, I have some questions:

Z12.4 - Screening pap smear of cervix in the absence of sign, symptom or history.
Z01.419 - Screening pap smear of cervix in the absence of sign, symptom or history, smear collected as part of gynecological examination.

^^^ When/why would there be a pap without a gyno exam? Would the "default" code be Z12.4 or Z01.419?

Z12.72 - Screening pap smear of vagina in the absence of sign, symptom or history.

^^^ What if there is a specimen labeled "cervical/vaginal" collection? Ideally the specimen will be collected from both sites for the cytotech to review, if circumstances allow.
Would you use cervical as the "default" or vaginal as the "default"? Or is there another code out there that specifies BOTH cervical and vaginal collection?

Thanks in advance for your help!!!
Jen
 
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811
Best answers
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Hello,

Maybe one of you can help clarify these different scenarios for me? I work in a pathology lab, so we do not see patients at all, we are given the specimen and requisition form for testing from the physician.
We go off what is specified on the requisition form that accompanies the pap smear to determine where it was collected from. However, I have some questions:

Z12.4 - Screening pap smear of cervix in the absence of sign, symptom or history.
Z01.419 - Screening pap smear of cervix in the absence of sign, symptom or history, smear collected as part of gynecological examination.

^^^ When/why would there be a pap without a gyno exam? Would the "default" code be Z12.4 or Z01.419?

Z12.72 - Screening pap smear of vagina in the absence of sign, symptom or history.

^^^ What if there is a specimen labeled "cervical/vaginal" collection? Ideally the specimen will be collected from both sites for the cytotech to review, if circumstances allow.
Would you use cervical as the "default" or vaginal as the "default"? Or is there another code out there that specifies BOTH cervical and vaginal collection?

Thanks in advance for your help!!!
Jen


Z01.419 is for a routine gynecological exam, which includes a cervical smear, if performed, with no abnormal findings. You do not code the smear separate as it's inclusive of the visit. It's an EXAM, not a SCREENING. If there are abnormal findings during the exam, then you'd code those separately. "Abnormal findings" doesn't necessarily apply strictly to an abnormal pap; anything that seems out of the ordinary could be abnormal, like a rash, discoloration, etc. It might be a stretch here, but a comparison example could be a routine annual health screening with your PCP. He/she will look in your eyes and ears, but you wouldn't bill for a screening of the eye as it's part of the annual exam.

Z12.4 is for a SCREENING for malignant neoplasm of cervix - basically a pap smear with a specific purpose; to evaluate for possible neoplasm of the cervix. There doesn't have to be a gyno exam to accompany it, but it could accompany an E/M visit. An example of the purpose for the code might be; someone has a routine exam and pap, the pap comes back abnormal, so the provider will need to perform additional paps to monitor the situation due to the abnormal results. There would be no reason to have a full-blown exam, just a repeat pap. The purpose is to monitor possible cervical cancer so that it can be treated early.

Z12.72 is for a screening for malignant neoplasm of vagina. This is similar to Z12.4 except instead of screening for cervical cancer, you're screening for vaginal cancer.

If you get a specimen that says "cervical/vaginal," it's because it's coming from the same place, the vagina. If they are asking for you to to run tests for both cervical and vaginal, the primary DX would be the primary purpose of the visit. If the primary purpose of the visit is both of those items, then it wouldn't matter what order they go in, as long as there's nothing else happening on that claim.


So it goes like this:

Z01.419 - routine, run-of-the-mill, exam and pap
Z12.4 - a specimen collection pap to test for cervical cancer (speaking generically)
Z12.72 - a specimen collection to test for vaginal cancer (speaking generically)
 
Last edited:

pookergirl

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Z01.419 and Z00.00 on requisition, which one to use for pap?

I do outpatient facility coding for path/lab/x-ray. Oftentimes, an OB/GYN office will send an order in with a pap smear and the codes on the order will be Z01.419 and Z00.00. Both are principal diagnoses only so I'm curious which one I'm supposed to use. I thought since it's only a pap being sent it with an HPV screen, then I'd use the z01.419 with Z11.51 for the HPV screening. QA person think I should still add the Z00.00 even though it can only be listed as principal. This has become very frustrating trying to figure out how to code these.

Also, when a general practitioners office sends a pap smear in and orders only state Z00.00, will Z00.00 be appropriate to cover pap and HPV screen? I've been adding Z12.4 and Z11.51 to the Z00.00 per instructions from higher ups and I'm unsure about this.

Thanks in advance for any input.
 
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I do outpatient facility coding for path/lab/x-ray. Oftentimes, an OB/GYN office will send an order in with a pap smear and the codes on the order will be Z01.419 and Z00.00. Both are principal diagnoses only so I'm curious which one I'm supposed to use. I thought since it's only a pap being sent it with an HPV screen, then I'd use the z01.419 with Z11.51 for the HPV screening. QA person think I should still add the Z00.00 even though it can only be listed as principal. This has become very frustrating trying to figure out how to code these.

Also, when a general practitioners office sends a pap smear in and orders only state Z00.00, will Z00.00 be appropriate to cover pap and HPV screen? I've been adding Z12.4 and Z11.51 to the Z00.00 per instructions from higher ups and I'm unsure about this.

Thanks in advance for any input.

If you're billing code Z01.419, you can add the HPV screening code Z11.51. However, you can't add Z12.4 because the services described in that code are included in the services for Z01.419.
Z01.419 - "Excludes1: screening cervical pap smear not a part of a routine gynecological examination (Z12.4)"

If you're getting an order coded as just Z00.00, then by definition, any associated labs coming from that encounter would already be included and not reported separately (eg, Z11.51, D12.4).
I found this example, although it's radiology, it's the same principal.
"Example: A patient is referred to the radiology department for a chest X-ray as part of a routine physical examination.
Code Z00.00, Encounter for general adult medical examination, is listed as the reason for the encounter because there are no presenting symptoms and the X-ray was not performed to rule out any suspect disease."
http://californiahia.org/sites/cali...Z00.00-med-exam-without-abnormal-findings.pdf

You're not forbidden to report Z00.00 and Z01.419 together, but you're required to code to the highest degree of specificity, and using code Z00.00 isn't as specific as Z01.419 for the pap (which isn't reported separately) and Z11.51. Also, if you have Z00.00 on the claim, then you'd be stuck on whether or not you could code Z11.51.

IMO, if the order has Z00.00 and Z01.419, and there are no abnormal findings, then you'd code Z01.419, Z11.51.
If Z00.00 is the only thing on the order, that's all you can report.
 
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