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Diagnosis Codes for Annual, Pap smear, hysterectomy, hx cancer

  1. Default Diagnosis Codes for Annual, Pap smear, hysterectomy, hx cancer
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    Which diagnosis codes do you use for Preventative GYN visit 993xx and 88175 Pap smear, patient has had a hysterectomy due to endometrial cancer and vag Pap is done. Would Z01.419, Z90.710, Z85.42 be correct?

    Would the same diagnosis codes used for this for both commercial insurance or Medicare?

  2. #2
    For all insurance except Medicare, I use the routine preventive 99381-99397. I use diagnosis Z01.419 mostly, with the occasional Z01.411. Z00.00 is required for Medicaid. They will deny Z01.419. For Medicare, I use G0101 and Q0091 with Z01.419, Z12.4 or Z01.411, unless they are high risk.

    Medicare covered codes for low risk: Z01.411, Z01.419, Z12.4, Z12.72, Z12.79, and Z12.80
    Medicare covered codes for high risk: Z77.22, Z77.9, Z91.89, Z72.89, Z72.51, Z72.52, and Z72.53.

    I find that if Z72.51 is the only code, Medicare has been denying 88175 for dx not covered.

    Since the patient is s/p hysterectomy, I would use the diagnosis for encounter for screening for malignant neoplasm of vagina, with a secondary code for acquired absence of both uterus and cervix (if that's what was removed. There are other codes for partial absence, etc.)

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