# High Risk Patients for Pelvic and Breast Exam Codes



## jwalker1 (Nov 4, 2015)

Is anyone having trouble with Medicare denials for the high risk patients for their gyn exams? We use to use the code V15.89 and now we are using Z77.9 but our claims have been denied for invalid code. Any suggestions as to what code should be used for these patients who need to be seen more than every 2 years and are high risk?


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## hamlinr2005 (Nov 13, 2015)

I hope this information I found online helps. These are the ICD-10 codes Medicare would like with collection of pap smear and pelvic exam. I found this on the acog.org website

• Z01.411 Encounter for gynecological examination (general) (routine) with abnormal findings
• Z01.419 Encounter for gynecological examination (general) (routine) without abnormal findings
• Z12.4 Encounter for screening for malignant neoplasm of cervix
• Z12.72 Encounter for screening for malignant neoplasm of vagina
• Z12.79 Encounter for screening for malignant neoplasm of other genitourinary organs
3
• Z12.89 Encounter for screening for malignant neoplasm of other sites
• Z77.9 Other contact with and (suspected) exposures hazardous to health
• Z91.89 Other specified personal risk factors, not elsewhere classified

Z77.9 is listed but I am wondering if they are wanting Z91.89.


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## ntreber (Nov 19, 2015)

per Medicare Preventive Services Guide ( ICN 006559 October 2015) for screening Pelvic exam and screening pap test 
High risk ICD-10 codes are Z77.22,Z77.9,Z91.89,Z72.89,Z72.51,Z72.52 and Z72.53


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