Pathology/Lab Coding Alert

Consensus Guidelines for Cervical Cytological Abnormalities. "The Bethesda distinction is crucial because the ASCCPguidelines recommend HPV testing for ASC-US findings but not for ASC-H findings which should proceed to a follow-up colposcopy " says Edward Wilkinson MD past-president of ASCCPand chairman of the consensus guidelines steering committee.

Solution #1: The new ICD-9 codes change the definitions to match the Bethesda system:

795.01 -- Papanicolaou smear of cervix with atypical squamous cells of undetermined significance (ASC-US)

795.02 -- Papanicolaou smear of cervix with atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H).

Problem #2: Prior to the 2005 ICD-9 changes corresponding CIN and Bethesda findings sometimes indicated different diagnosis codes. For example 622.1 (Dysplasia of cervix [uteri]) reported high-grade SIL (HSIL) findings but the same pathology report may also indicate CIN III which is 233.1 (Carcinoma in situ of cervix uteri).

Solution #2: ICD-9 2005 deletes HSIL from the 622.1 cervical dysplasia code definition and creates a new code for HSIL (795.04 Papanicolaou smear of cervix with high-grade squamous intraepithelial lesion [HGSIL]). The ICD-9 changes also clarify that 622.1 is based on cytologic and histologic findings while 795.00-795.09 are for cervical cytologic examination without histologic confirmation.

Do this: "Report HSIL using 795.04 when you have only Pap smear [cytologic] findings and report 233.1 when histologic findings indicate both HSIL and CIN III " Witt says. "The distinction removes any confusion about which code to report when the pathology report indicates both HSIL and CIN III."

You Can List an Inadequate Pap Smear

In October you'll have a new code to report an inadequate Pap smear -- 795.08 (Nonspecific abnormal Pap smear of cervix unsatisfactory smear). The code description specifies inadequate sample.

"Whether your payers will cover this code you should report 795.08 to describe an inadequate Pap smear which may indicate medical necessity for a repeat smear " Witt says.

Watch for the 5th Digit - Don't Truncate Codes

ICD-9 2005 adds 11 new five-digit codes to report cervical cytology and histology findings. See Quick Key: Implement These ICD-9 Codes for Pap Smears  for a complete listing of the new codes as well as code revisions.

Remember that you must assign the fifth digit when it's available. Medicare doesn't accept "truncated codes" -- codes reported to only the third or fourth digit when ICD-9 lists a more specific five-digit code. For example report 795.09 (Other abnormal Papanicolaou smear of cervix and cervical HPV) rather than 795.0 (Nonspecific abnormal Papanicolaou smear of cervix) for a nonspecific abnormal Pap that provides no further information.

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