Pathology/Lab Coding Alert

Showing medical necessity means choosing the right V code.

If youre using V72.31 (Routine gynecological examination) or V76.2 (Special screening for malignant neoplasm; cervix) to report a screening human papillomavirus (HPV) test in addition to a Pap test, think again.

Although intricately tied to cervical cancer, testing for HPV isnt always necessary to diagnose the disease. Thats why you must use a different V code to demonstrate that the physician specifically ordered a medically-necessary HPV test in addition to a Pap test.

That code is V73.81 (Special screening examination for viral and chlamydial diseases; other specified viral and chlamydial diseases; human papillomavirus [HPV]).

Dont Assume HPV Testing Necessity

HPV testing presents a dilemma, according to Melanie Witt, RN, CPC, COBGC, MA, a coding expert based in Guadalupita, N.M. Although virtually every woman who develops significant squamous lesions first had an HPV infection, most women who have an HPV infection never develop significant intraepithelial neoplasia, she explains.

Thats why routine HPV screening wont provide much valuable diagnostic information.

Follow these recommendations: The Food and Drug Administration (FDA) has approved HPV screening for a patient whose Pap test shows atypical squamous cells of undetermined significance (ASC-US) cytology (795.01).

If the Pap test is a liquid-based preparation, you can perform the HPV test on the original sample, Witt says.

Or the lab may perform an HPV test on a sample taken separately from a conventional Pap smear when the physician orders the test.

Use Most Specific Code(s)

Because ICD-9 provides a specific HPV screening code (V73.81), you cant use more general screening codes and expect payment for the HPV test.

Physicians used to send Pap and HPV tests to the lab with the annual gynecological exam as the ordering diagnosis (V72.31). Now ICD-9 clarifies that you must additionally list a diagnosis code for the Pap test (such as V76.2) and the HPV test (V73.81).

Be organism-specific: Although V74.5 (Special screening examination for bacterial and spirochetal diseases; venereal disease) might accurately describe an HPV test, ICD-9 clarifies that you should use the morespecific V73.81 to report an HPV test. The text note following V74.5 says that the code excludes special screening for nonbacterial sexually transmitted diseases (V73.81-V73.89, V75.4, V75.8).

Watch for New Tests

The FDA recently approved two new HPV DNA tests -- one that identifies the two HPV types that cause most cervical cancers, and one that detects virtually all of the high-risk HPV types.

The tests are Cervista HPV 16/18 and Cervista HPV HR, which the Madison, Wis.-based Third Wave Technologies manufactures.

Results from these two tests, when considered with a physicians assessment of the patients history, other risk factors, and professional guidelines, can help physicians better determine risk and could lead to better patient management, said Daniel G. Schultz, M.D., director of the FDAs Center for Devices and Radiological Health in a statement announcing the approval.