Pathology/Lab Coding Alert

Discover a new way to report vaginal findings. You already know to look to ICD-9 category 795 for codes to support your Pap test claims, but you-ll have a total of 20 new code options to report Pap results 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. Capture Vaginal Results with Expanded 795.1x ICD-9 2009 adds nine new five-digit codes just for vaginal Pap-smear results. Prior to this change, you had to use a single, non-specific code for vaginal smears, regardless of the results. Now the vaginal codes parallel the cervical codes, and you can report specific cytologic findings. Old way: Prior to Oct. 1, you should use 795.1 (Nonspecific abnormal Papanicolaou smear of other site) 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," says Melanie Witt, RN, CPC-OGS, MA, an independent coding consultant from Guadalupita, N.M. New way: Starting Oct. 1, you should select the appropriate code for vaginal Pap test results from the following list: - 795.10 -- Abnormal glandular Papanicolaou 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) - 795.15 -- Vaginal high risk papillomavirus (HPV) DNA test positive - 795.16 -- Papanicolaou smear of vagina with cytologic evidence of malignancy - 795.18 -- Unsatisfactory cytology smear Inadequate vaginal cytology sample - 795.19 -- Other abnormal Papanicolaou smear of vagina and vaginal HPV. Catch this: To clarify the new distinction between cervical and vaginal Pap smear results, ICD-9 revises text notes and existing codes. For instance, the "excludes" note following 795.0 adds this exclusion: abnormal cytologic smear of vagina and vaginal HPV (795.10-795.19). The note also revises exclusions for mild dysplasia (622.11) moderate dysplasia (622.23) and severe dysplasia (233.1) by adding the descriptor "cervical" to the definitions. A new note under 623.0 specifies, "Mild and moderate dysplasia of vagina." Revision: ICD-9 also revises 795.08 (Unsatisfactory smear) to (Unsatisfactory cervical cytology smear) as of Oct. 1, meaning that you-ll only use the code for cervical Pap smear specimens. Don't miss HPV: Notice that the ICD-9 changes include codes that "will be helpful with the new focus on HPV diagnosis and prevention that we-re seeing in medical [...]