Pathology/Lab Coding Alert

New cervical ICD9 Codes mean more specific diagnoses for coders and perhaps more money for pathologists. The annual ICD-9 update (effective Oct. 1 with a grace period through Dec. 31) details new codes for reporting nonspecific abnormal Pap smears, and may open the door for additional test coverage.

New code 795.09 (Other nonspecific abnormal Papanicolaou smear of cervix) could impact Medicare and other insurance payments because the words "unsatisfactory smear" were added to the description, says Dennis Padget, CPA, FHFMA, president of Padget & Associates, a pathology compliance-consulting firm in Simpsonville, Ky. "Historically, labs have not classified unsatisfactory smears as either normal or abnormal," he says. When labs get an unsatisfactory Pap test, they often use the diagnosis the referring physician submitted usually a V code, such as V76.2 (Routine cervical Papanicolaou smear), he adds. But if "unsatisfactory" is now to be classified as abnormal using code 795.09, Medicare and other insurers may cover both a pathologist's evaluation of the smear and more frequent follow-up testing because the patient now has a "history of abnormal Pap," Padget says.

That is, if CMS doesn't change anything in the interim, he cautions. Be alert for payment policy clarifications that counteract the increased payments that would be a natural consequence of this ICD-9 code change.

Abnormal Pap Means Additional Procedure Coverage

Whether the initial Pap is ordered for screening or diagnostic purposes, if the cytotechnician reviews the smear and finds it abnormal, Medicare and other insurers cover a pathologist's interpretation service. Since 795.09 includes "unsatisfactory smear" as abnormal, payers may be covering more interpretations. And because Medicare considers a previous abnormal Pap as cause for more frequent testing, it may be covering more Pap smears as well, Padget says. "Educate lab staff and referring physicians about the implications of this change on Pap coverage, coding and payment, but be cautious until we know for sure that the payment policy implications have been approved," he stresses.

Here are the steps to code for 1) the original Pap test, 2) the interpretation of an abnormal smear, and 3) follow-up Pap smears:

1. Assign the Pap smear procedure code based on the initial reason for the test, regardless of the results. For screening Pap smears of asymptomatic patients, report one of the HCPCS Level II codes (P3000, Screening Papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision; or G0123 or G0143-G0148, Screening cytopathology, cervical or vaginal ) depending on the method used. When performing a diagnostic Pap smear for a patient with signs or symptoms of disease, use 88142-88154, Cytopathology, cervical or vaginal ; or 88164-88167, Cytopathology, slides, cervical or vaginal.

If the Pap test results are abnormal and the pathologist interprets the slides, report an additional procedure code based on the original Pap code used. "Although they may not be billed by the same entity, each CPT or HCPCS Pap smear code can only properly be paired with one of the Pap interpretation codes," says Stacey Hall, RHIT, CPC, CCS-P, director of corporate coding for Medical Management Professionals Inc., a billing and practice management firm headquartered in Chattanooga, Tenn.

2. "For the interpretation of a screening Pap (reported with a HCPCS Level II code), use one of the HCPCS interpretation codes," Hall explains. These codes are:
 

"If the interpretation is for a diagnostic Pap reported with a CPT code, use the only CPT physician Pap interpretation code: +88141 (Cytopathology, cervical or vaginal [any reporting system]; requiring interpretation by physician [list separately in addition to code for technical service])," Hall says.

3. For a follow-up Pap smear after an abnormal test, don't use the screening diagnosis codes as the reason for the test (e.g., V76.2), or the HCPCS Level II procedure codes. Instead, report the service using the appropriate diagnostic Pap CPT code (88142-88154 or 88164-88167).