Pathology/Lab Coding Alert

Question: We began reporting screening Pap smears for patients who have previously had a hysterectomy using ICD9 V76.49 as described by Medicare. However, our local carrier is denying these claims, saying diagnosis code V76.49 is not a payable diagnosis for Pap smears, only for pelvic examinations. They are instructing us to use V76.2, which is a cervical code even though the patient does not have a cervix. Which is the correct code for these situations?

Florida Subscriber

  
Answer: You are correct to report V76.49 (special screening for malignant neoplasms, other sites) rather than V76.2 (special screening for malignant neoplasms, cervix) as the diagnosis code for a screening Pap smear for a patient who has previously had a hysterectomy.
 
In an update to Medicare Carriers Manual Part 3, transmittal 1675 on Aug. 31, 2000, instructions are provided for reporting the diagnosis for a pelvic exam and screening Pap smear for women at low risk for cervical cancer who do not have a uterus or cervix. Section 4603.2 C says, There are a number of appropriate diagnosis codes that can be listed in Item 21 of the HCFA 1500 claim form for Pap smear or pelvic exam claims in addition to V76.2 or V76.49 (for low-risk patients) However, one of the diagnosis codes in item 21 for low-risk beneficiaries must be V76.2 or V76.49, and this is the diagnosis code that must be pointed to in Item 24E of the HCFA 1500. You must use one of these two codes, and V76.2 does not accurately describe the service supplied for a patient with no cervix.

 
Answers to Reader Questions and You Be the Coder provided by Laurie Castillo, MA, CPC, CPC-H, CCS-P, president of Physician Coding and Compliance in Manassas, Va.