Ob-Gyn Coding Alert

Question: Could you help with the following lab questions?

• When an ASCUS Pap is reflexed to HPV, is it proper to still use the HPV screening ICD-10 code?
• When a test is added should the order for the date the specimen was obtained be amended to reflect the add-on test/code, or should a new order be created, and then use the date the decision was made to do more testing on that specimen be used to bill the add on test?
• Would it be the same situation for adding HPV when it was not ordered to reflex on the original Pap order? i.e., still considered screen HPV?
• How about for a urine culture? When it becomes a positive culture (2-3 days), and an ID and sensitivity is ordered, do you use the date you actually order the ID and sensitivity, or do you go back to the original specimen collection date for billing and also amend the diagnosis?

Thanks in advanced any feedback on this!

Coding Institute Forum subscriber

Answer: The date is the date the ob-gyn ordered the additional test, and that is the date the lab would use.

If the HPV test (for instance, 87624, Infectious agent detection by nucleic acid (DNA or RNA); Human  Papillomavirus (HPV), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) is required due to an ASCUS Pap finding, your diagnosis for the HPV test will be ASCUS Pap (R87.610, Atypical squamous cells of undetermined significance on cytologic smear of cervix (ASC-US)), not he screening diagnosis indicated by the provider for the initial Pap examination. This is based on the ICD-10-CM rule that if a test is ordered as screening, but as a result there is an abnormal finding, the finding would be coded as a secondary code. However, this change in coding will be done by the laboratory, not the physician’s office.

If the HPV is simply done as a screening test, then you should use the screening diagnosis (Z11.51, Encounter for screening for human papillomavirus (HPV)).

The same goes for the urine culture (for instance, 87086, Culture, bacterial; quantitative colony count, urine). If this original test shows a finding that led to an ID and sensitivity(for instance, 87088, Culture, bacterial; with isolation and presumptive identification of each isolate, urine), the diagnosis the lab uses is now the finding, such as R82.71 (Bacteriuria).

As a provider, you cannot change the dx on the original order; the lab will change it for the additional test only. The ICD rules indicate clearly that a screening is still reported as screening — even if there is a finding on the original reason for testing. However, if the additional testing is done for an abnormal finding, you would code it with the finding to support doing the additional test.