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High risk vaginal ca screening

  1. #1
    Default High risk vaginal ca screening
    Medical Coding Books
    Ok, this may be a dumb question but I tend to be a literal person and in this case, the literature is a little confusing to me! What does Medicare consider High Risk for vaginal ca screening? Our carrier (NHIC) lists the high risk elements like this for the G0101:
    The factors for women who are considered high-risk and are of childbearing age, who have had an examination that indicated the presence of cervical or vaginal cancer or other abnormality during any of the preceding two years are:
     Cervical Cancer High Risk Factors
    o Early onset of sexual activity (under 16 years of age)
    o Multiple sexual partners (five or more in a lifetime)
    o History of a sexually transmitted disease (including HIV infection)
    o Fewer than three negative or any Pap smears within the previous 7 years
     Vaginal Cancer High Risk Factors
    o DES (diethylstilbestrol) exposed daughters of women who took DES during pregnancy.

    Does this mean if a patient no longer has a cervix, they're only considered high risk if they've been exposed to DES? The cervical and vaginal cancer high risk factors are NOT separated out under their section for screening paps:
     The patient is at high risk of developing cervical or vaginal cancer and at least 11 months
    have passed following the month that the last covered screening pap smear was performed.
    The high risk factors for cervical and vaginal cancer are:
    1) Early onset of sexual activity (under 16 years of age)
    2) Multiple sexual partners (5 or more in a lifetime)
    3) History of a sexually transmitted disease (including HIV infection)
    4) Fewer than three negative or any Pap smears within the previous 7 years
    5) DES (diethylstilbestrol)-exposed daughters of women who took DES during pregnancy.

    Am I ok to bill for both the G0101 & Q0091 as high risk if the pt has a history of HPV? Help!
    Thanks,
    Sue
    Sue Vermette, CPC, CPMA

  2. #2
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by SUEV View Post
    Ok, this may be a dumb question but I tend to be a literal person and in this case, the literature is a little confusing to me! What does Medicare consider High Risk for vaginal ca screening? Our carrier (NHIC) lists the high risk elements like this for the G0101:
    The factors for women who are considered high-risk and are of childbearing age, who have had an examination that indicated the presence of cervical or vaginal cancer or other abnormality during any of the preceding two years are:
     Cervical Cancer High Risk Factors
    o Early onset of sexual activity (under 16 years of age)
    o Multiple sexual partners (five or more in a lifetime)
    o History of a sexually transmitted disease (including HIV infection)
    o Fewer than three negative or any Pap smears within the previous 7 years
     Vaginal Cancer High Risk Factors
    o DES (diethylstilbestrol) exposed daughters of women who took DES during pregnancy.

    Does this mean if a patient no longer has a cervix, they're only considered high risk if they've been exposed to DES? The cervical and vaginal cancer high risk factors are NOT separated out under their section for screening paps:
     The patient is at high risk of developing cervical or vaginal cancer and at least 11 months
    have passed following the month that the last covered screening pap smear was performed.
    The high risk factors for cervical and vaginal cancer are:
    1) Early onset of sexual activity (under 16 years of age)
    2) Multiple sexual partners (5 or more in a lifetime)
    3) History of a sexually transmitted disease (including HIV infection)
    4) Fewer than three negative or any Pap smears within the previous 7 years
    5) DES (diethylstilbestrol)-exposed daughters of women who took DES during pregnancy.

    Am I ok to bill for both the G0101 & Q0091 as high risk if the pt has a history of HPV? Help!
    Thanks,
    Sue
    HPV is sexually transmitted so a previous positive screening for it qualifies for yearly pap screening Q0091 and pelvic exam/breast exam G0101. You would use diagnosis codes to indicate it was a screening for malignant neoplasm of the vagina V76.47 along with 795.05 for positive cervical HPV or 795.15 for positive vaginal HPV and then the V88 code that relates to the acquited absence of the uterus and/or cervix.
    Last edited by ajs; 11-07-2011 at 03:26 PM. Reason: addition
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. #3
    Default
    Hi Arlene,
    Thanks for responding. Our carrier states that if it's high risk, we would also use V15.89. So, in your scenario of yearly vaginal paps with a history of HPV, would you say this qualifies for the V15.89 every year?
    Thanks-Sue
    Sue Vermette, CPC, CPMA

  4. #4
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by SUEV View Post
    Hi Arlene,
    Thanks for responding. Our carrier states that if it's high risk, we would also use V15.89. So, in your scenario of yearly vaginal paps with a history of HPV, would you say this qualifies for the V15.89 every year?
    Thanks-Sue
    Based on their definition yes it should.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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