Ob-Gyn Coding Alert

Discover a new way to report the acquired absence of the cervix You already know to look at the 795 series for ICD-9 codes to support your cervical Pap smear claim, but you-ll have a total of 20 new smear options for 2009. Relax, though. Our experts break down the rationale behind these new codes and alert you to the benefits so you-ll be ready to start using them Oct. 1. Note: Now these codes appear in a "proposed" rule. CMS may announce more changes that will go into effect Oct. 1, so keep a close watch on your Ob-Gyn Coding Alert for more details. Expand Your Anal Smear Coding Options Starting on Oct. 1, if your ob-gyn performs an anal smear, you-ll need to look to the new 796.7x series. Rationale: The risk of dysplasia and carcinoma is the same for the anus as it is for the cervix, so physicians can take anal cytologic smears. The cervix and the anus both have transformation zones where mucosa turns from squamous to columnar, so ICD-9 created parallel codes for anal smears effective on Oct. 1. When your physician performs a Pap smear of the anus, you-ll use one of the new codes (796.70-796.78, Papanicolaou smear of anus -). Like the codes for Pap smears for the vagina (see below), you-ll use 796.70 (Abnormal glandular Papanicolaou smear of anus) for an abnormal smear, whereas for anal Pap smears with ASC-US, you-ll report 796.71 (Papanicolaou smear of anus with atypical squamous cells of undetermined significance [ASC-US]). Note: You-ll report dysplasia of anus with new code 569.44 (Dysplasia of anus). Make These -No Transformation Zone- Modifications In creating these new anal smear codes, ICD-9 had to modify the existing abnormal cervical cytology codes to indicate a result where the transformation zone is not present in the specimen. For instance, ICD-9 2009 brings you 795.07 (Satisfactory cervical smear but lacking transformation zone) and 796.77 (Satisfactory anal smear but lacking transformation zone). "This is an important distinction," says Melanie Witt, RN, CPC-OGS, MA, an independent ob-gyn coding consultant in Guadalupita, N.M. This transformation zone changes position in response to a woman's hormonal changes, Witt says. "A woman who is postmenopausal may have no endocervical cells in the transformation zone, but the smear would still be considered satisfactory due to her status." Also, because the vagina and vulva do not have transitional zones (and are only composed of a squamous cell lining), ICD-9 decided to expand and redefine subcategory 795.1 for the abnormal smear of the vagina and vulva: - 795.10 -- Abnormal glandular Papanicolaou smear of vagina - 795.11 -- Papanicolaou smear of vagina with atypical squamous cells of undetermined significance (ASC-US) - 795.12 -- [...]