Ob-Gyn Coding Alert

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.

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).

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:

Bonus: You also have code 795.18 (Unsatisfactory cytology smear).

Keep in mind: Prior to Oct. 1, you should use 795.1 for any abnormal Pap result from a site other than the cervix. "Right now, 795.1 is the correct code to report abnormal smears of the vagina, anus or even the breast," Witt says.

Catch this: Of the new smear codes, you-ll also find codes that "will be helpful with the HPV diagnosis and prevention that we-re seeing practices focus on," says Randall Karpf with East Billing in East Hartford, Conn. ICD-9 2009 offers you four new options:

Revision: You should note that 795.08 (Unsatisfactory smear) will transform to Unsatisfactory cervical cytology smear as of Oct. 1.

Now you have V45.77 (Acquired absence of genital organs) at your disposal, but the American College of Obstetricians and Gynecologists (ACOG) requested a unique code for the acquired absence of cervix -- and got three.

These three new V codes will help track Pap smear necessity: V88.01 (Acquired absence of both cervix and uterus), V88.02 (Acquired absence of uterus with remaining cervical stump), and V88.03 (Acquired absence of cervix with remaining uterus).

Note: You can possibly use these codes in conjunction with V67.01 (Follow-up vaginal Pap smear) and V76.47 (Special screening for malignant neoplasm of vagina).

Revision: Code V45.71 will state "Acquired absence of breast and nipple."