Pathology/Lab Coding Alert

Starting Oct. 1, you won't have catch-all code 795.1 (Non specific abnormal Papanicolaou smear of other site) to throw your anal Pap test results into anymore.

Instead, you-ll need to learn how to use nine new codes in new subcategory 796.7 (Abnormal cytologic smear of anus and anal HPV).

Don't rush: Remember that until the new codes become effective, you should continue to use a single code for any abnormal Pap result from a site other than the cervix. Right now, 795.1 is still the correct code to report abnormal anal Pap smears, according to Melanie Witt, RN, CPC-OGS, MA, an independent coding consultant from Guadalupita, N.M.

Watch for invalid code: After Oct. 1, 795.1 will be invalid, as ICD-9 will require you to report a fifth digit with the code. The new five-digit codes in the 795.1x range (Abnormal Papanicolaou smear of vagina and vaginal HPV) are specific for vaginal Pap smears and HPV tests, and you can learn more about the codes in "Brace Yourself for a Plethora of New Pap Test Codes" on page xxx of this issue.

When your lab processes Pap test specimens from the anus, you-ll need to report the abnormal findings more specifically with nine new codes.

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 the following parallel codes for anal smears effective on Oct. 1:

- 796.70 -- Abnormal glandular Papanicolaou smear of anus

- 796.71 -- Papanicolaou smear of anus with atypical squamous cells of undetermined significance (ASC-US)

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

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

- 796.74 -- Papanicolaou smear of anus with high grade squamous intraepithelial lesion (HGSIL)

- 796.75 -- Anal high-risk human papillomavirus (HPV) DNA test positive

- 796.76 -- Papanicolaou smear of anus with cytologic evidence of malignancy

- 796.77 -- Satisfactory anal smear but lacking transformation zone

- 796.78 -- Unsatisfactory anal cytology smear

- 796.79 -- Other abnormal Papanicolaou smear of anus and anal HPV.

Dysplasia of anus receives a new code in ICD-9 2009: 569.44 (Dysplasia of anus).

Tip: Starting this fall, use 569.44 when your pathologist reports histologic findings, not just cytologic findings from a Pap smear, such as "Anal intraepithelial neoplasia I and II (AIN I and II)," or "mild and moderate dysplasia of anus," or a non-specific histologic diagnosis of "dysplasia of anus."

Exclusions: Code 569.44 will exclude abnormal results from anal cytologic examination (Pap tests) without histologic confirmation (796.70-796.79), anal intraepithelial neoplasia III (230.5, 230.6), carcinoma in-situ of anus (230.5, 230.6), and severe dysplasia of anus (230.5, 230.6).