Pathology/Lab Coding Alert

Question: I've heard that we should report Bethesda's Pap categories of
ASCUS and ASCH using ICD9 795.01 , a code that was new in ICD-9-CM 2002 and remained unchanged in the 2003 edition. Why shouldn't we report these findings as 795.02, and can we expect ICD-9 to update the codes to match Bethesda categories?

California Subscriber
 
Answer: Coders have been frustrated by the lack of alignment between Bethesda terminology and updated ICD-9-CM codes since the problem arose in October 2002. You are correct that ICD-9-CM 2003 did not change the problematic codes. However, the ICD-9-CM Coordination and Maintenance Committee is considering changes for ICD-9 2004. Among the changes the committee is considering is the addition of atypical squamous cells of undetermined significance (ASCUS) to the 795.01 code definition and the addition of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASCH) to the 795.02 code definition.
 
But until ICD-9-CM implements those changes, you have to code according to the current definitions: 795.01 (Atypical squamous cell changes of undetermined significance favor benign [ASCUS favor benign]) and 795.02 (Atypical squamous cell changes of undetermined significance favor dysplasia [ASCUS favor dysplasia]).
 
"People certainly debate correct coding of Bethesda ASCUS and ASCH under current ICD-9-CM terminology, but most of the 80 or so physicians I've spoken with agree that these two Bethesda categories best fit under 795.01, especially because using 795.02 would be labeling the patient as having dysplasia when she may not," says Melanie Witt, RN, CPC, MA, an independent coding educator based in Fredericksburg, Va., and former program manager for the American College of Obstetricians and Gynecologists department of coding and nomenclature.

 - Reader Questions and You Be the Coder were prepared with the assistance of Laurie Castillo, MA, CPC, CPC-H, CCS-P, president of Professional Coding and Compliance Consulting in Manassas, Va.