Part B Insider (Multispecialty) Coding Alert

Discover new ways to code for Pap tests, OB conditions

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 that you-re ready to start using them Oct. 1.

Note: Currently, these codes appear in a -proposed- rule. CMS may announce more changes that will go into effect Oct. 1, so keep an eye on the Insider for more details.

New for October: If your physician performs an anal smear on or after Oct. 1, you-ll need to look to the new 797.7x 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 Oct. 1.

When your physician performs a Pap smear of the anus after Oct. 1, you-ll use one of the new codes (796.70-796.78, Papanicolaou smear of anus -). Like the codes for vaginal Pap smears [see below], you-ll use 796.70 (Abnormal glandular Papanicolaou smear of anus) for an abnormal smear, but 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 make modifications to 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 from Guadalupita, N.M.  This transformation zone changes position in response to a woman's hormonal changes, says Witt. -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, as follows:

- 795.10--Abnormal Papani-colaou smear of vagina

- 795.11--Papanicolaou smear of vagina with atypical squamous cells of undetermined significance (ASC-US)

- 795.12--Papanicolaou smear of vagina with atypical squamous cells cannot exclude high grade squamous intraepithelial lesion (ASC-H)

- 795.13--Papanicolaou smear of vagina with low grade squamous intraepithelial lesion (LGSIL)

- 795.14--Papanicolaou smear of vagina with high grade squamous intraepithelial lesion (HGSIL).

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.  

Hematuria and urinary incontinence: If the patient has blood in the urine, or -hematuria,- you have three new codes to represent this condition. They are 599.70 (Hematuria, unspecified), 599.71 (Gross hematuria) and 599.72 (Microscopic hematuria).   

Note: If your encounter form currently lists 599.7 as an option, you will start getting denials after Oct. 1 unless you remember to list one or more of the now 5 digit codes for this condition, Witt warns.

In addition, you have a new code for urinary incontinence: 788.91 (Functional urinary incontinence). Functional urinary incontinence occurs when a patient suffers impairment to the ability to control her bladder function. ICD-9 also adds 788.99 (Other symptoms involving urinary symptoms).