Ob-Gyn Coding Alert

Question: A patient came in for her annual routine exam. While she was in the exam room, she requested a STD screening as well. Doctor did annual exam with Pap and took cultures for the STD screening. What would be the best way to code this visit? The ob-gyn used V72.31 and V73.88. Is this correct?

Massachusetts Subscriber

Answer: The STD tests the ob-gyn ordered determines the code. For gonorrhea and syphilis, the code is V74.5 (Special screening examination for bacterial and spirochetal diseases; venereal disease); for chlamydia the code is V73.88 (Other specified chlamydial diseases); for HPV, it is V73.81 (Special screening examination, human papillomavirus [hpv]); and hepatitis is V73.89 (Other specified viral diseases).

ICD-10: When your diagnosis system changes:

• Code V74.5 will become will become Z11.3 (Encounter for screening for infections with a predominantly sexual mode of transmission)
• Code V73.88 will become Z11.8 (Encounter for screening of other infectious and parasitic diseases).
• Code V73.81 will become Z11.51 (Encounter for screening for human papillomavirus [HPV]).
• Code V73.89 will become Z11.59 (Encounter for screening for other viral diseases).

Remember: Your ob-gyn is not doing the culture; he is ordering the tests. Therefore, you should supply the lab with the screening diagnoses for the tests ordered.

If you are billing on behalf of the lab, then you must add modifier 90 (Reference [outside] laboratory) to each lab code. Every lab procedure must be supported with a diagnosis for ordering it or performing it. So in this case, V72.31 (Routine gynecological examination) is linked only to the routine exam code, and the other screening diagnoses are each linked to their respective lab tests.