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Pathology/Lab Coding Alert

Put Another V Code on Your Pap Screening List

Published on Sun Mar 06, 2005

CMS expands payable diagnoses

You can look forward to getting paid for screening Pap smears that physicians report as part of a routine gynecological exam, now that CMS added V72.31 to its list of covered codes.

Problem: When physicians collect a screening Pap smear as part of a routine gynecological exam and order the Pap test with the exam diagnosis code, Medicare won't pay for the Pap smear.

Solution: CMS is adding v72.31 (Routine gynecological examination) to the list of covered diagnosis codes for screening Pap smears effective July 1, according to Change Request 3659 issued Jan. 21. That means physicians won't have to use one diagnosis code to bill for the exam (V72.31) and a different diagnosis code to bill for the Pap smear.

Choose Screening Code for High- or Low-Risk

Medicare covers screening Pap smears once every two years for patients at low risk of developing cervical cancer or once a year for patients at high risk. Medicare considers patients who have any of the following documented factors to be high-risk: early onset of sexual activity, multiple sexual partners, history of sexually transmitted disease, fewer than three negative Pap smears within the previous seven years, and daughters of women who took DES (diethylstilbestrol) during pregnancy. Diagnosis V15.89 (Other specified personal history presenting hazards to health, other) is the only code Medicare accepts for screening Pap smears performed annually for high-risk patients.

For low-risk patients, Medicare only paid for screening Pap smears ordered with the following codes - until now:

  •  V76.2 - Special screening for malignant neoplasms; cervix
  •  V76.47 - Special screening for malignant neoplasms; vagina

  •  V76.49 - Special screening for malignant neoplasms; other sites.

    Beginning July 1, Medicare will also accept V72.31 for low-risk patients. The lab can now expect to get paid for Pap smears when a physician takes the Pap specimen as part of a complete gynecological exam and only reportsthe exam diagnosis code. The addition of V72.31 "actually makes it possible to code more accurately," says Jo Anne Steigerwald, RHIT, senior consultant with the Wellington Group in Valley View, Ohio.

    The change allows coders to clarify that the Pap smear was part of an overall gynecological examination, says coder Becky Swank with the Wichita Clinic in Wichita, Kansas. Now that V72.31 is part of the covered list for low-risk screening Pap smears, coders no longer have to order the Pap with a diagnosis code different from the comprehensive gynecological exam code. "This makes much more sense," Swank says.

    Caution: Don't use V72.31 for high-risk patients, even if the physician takes the Pap smear as part of a routine gynecological exam. CMS still requires V15.89 for all high-risk Pap smears, which allows an annual screening Pap smear. 

    Watch Out for Conveyance Frequency

    CMS' Change Request 3659 also adds frequency edits for Pap smear preparation charges. Physicians will no longer receive payment for Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) if they obtain a Pap smear more often than every two years for low-risk or every year for high-risk patients.

    Exception: Sometimes the lab determines that a Pap smear is insufficient for evaluation, and the physician must obtain a second specimen before the frequency limitation period of one or two years is up. That's when you need to use modifier -76 (Repeat procedure by same physician) to bypass the frequency edits for Q0091, CMS says.

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