Pathology/Lab Coding Alert

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.

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 practices," says Randall Karpf with East Billing in East Hartford, Conn.

In addition to existing codes for cervical HPV (795.05, Cervical high risk human papillomavirus [HPV] DNA test positive; and 795.09, Other abnormal Papanicolaou smear of cervix and cervical HPV), ICD-9 adds codes for vaginal HPV (795.15 and 795.19) as well as anal HPV (796.75, Anal high risk human papillomavirus [HPV] DNA test positive; and 796.76, Other abnormal Papanicolaou smear of anus and anal HPV). You can learn more about ICD-9's new anal Pap smear codes in subcategory 796.7 (Abnormal cytologic smear of anus and anal HPV) in "Take on 796.7 for Accurate Anal Pap Smear Coding" on page xxx of this issue.

ICD-9 2009 also creates a new code for specimens that don't capture the transformation zone: 795.07 (Satisfactory cervical smear but lacking transformation zone).

"This is an important distinction," Witt says. The transformation zone changes position in response to a woman's hormonal changes, she continues. "A woman who is postmenopausal may have no endocervical cells in the transformation zone, but you would still consider the smear satisfactory due to her status."

Starting Oct. 1, you-ll have three, new, specific ICD-9 codes to replace general code V45.77 (Acquired absence of genital organs) for tracking Pap smear necessity in patients who have had a hysterectomy.

The three new V codes are as follows:

- V88.01 -- Acquired absence of both cervix and uterus

- V88.02 -- Acquired absence of uterus with remaining cervical stump

- V88.03 -- Acquired absence of cervix with remaining uterus.

Note: You may use these codes in conjunction with V67.01 (Follow-up vaginal Pap smear) and V76.47 (Special screening for malignant neoplasm of vagina).