Ob-Gyn Coding Alert

New codes for Pap smear results, endometrial hyperplasia and genital prolapse mean more specificity With more than 40 new diagnosis codes that will affect ob-gyn practices beginning Oct. 1, now's the time to start familiarizing yourself with them. So dust off your office encounter forms and get ready to make changes.

The biggest and most welcome ICD-9 change is the rework of the Bethesda system codes for abnormal Pap smears, but you'll also see new codes for female genital mutilation and the expansion of the codes for genital prolapse, endometrial hyperplasia and dysplasia. ICD-9 also offers a new obstetric chapter code, several new symptom codes, and V-code changes that will help you identify patients'illness histories.

"All of these codes will help to more clearly define the actual diagnosis," says Judy Troy, an ob-gyn coder with 35 years of experience, and surgical coding coordinator for Capital Women's Care in Silver Spring, Md. "We often have to 'make do'with codes that were not entirely accurate."

More good news: Effective Oct. 1, all payers and providers must accept the new codes. CMS eliminated the grace period, so hopefully you can avoid those "invalid diagnosis" explanation-of-benefits messages and denials. Get More Specific With Pap Smear Results "The CDC's National Center for Health Statistics (NCHS) Classification of Diseases committee revised the codes for an abnormal Pap smear (795.0x) in October 2001 to match Bethesda system findings, which more than 90 percent of U.S. laboratories report," says Melanie Witt, RN, CPC, MA, an ob-gyn coding expert based in Fredericksburg, Va. Just before it implemented this revision, however, the Bethesda Committee revised its terminology so that the new codes were no longer a good match. After many meetings and discussions with the American College of Obstetricians and Gynecologists (ACOG) and others, the NCHS' ICD-9-CM Coordination and Maintenance Committee (ICMC) has effected what should permanently fix Pap smear result coding. First, the committee removed references to "favor benign" and "favor dysplasia" that the old codes included. Instead, the new codes reflect the hierarchy of conditions beginning with changes to the code's title. New title: Category 795 is now titled "Other and nonspecific abnormal cytological, histological, immunological and DNAtest findings." Next, the heading for 795.0 will change to allow coding for both an abnormal Pap smear and cervical human papilloma virus (HPV). And finally, new codes will allow you to report findings of high-grade squamous intraepithelial lesion (HGSIL) and a low-grade lesion (LGSIL) and to differentiate between these results and dysplasia. In other words, each result on the pathology report will probably have a specific diagnosis code to describe it, Witt says. The revised code category now also clearly details that you should not use a 795 category diagnosis [...]