Pathology/Lab Coding Alert

Question: Our lab performed a screening Pap test for a 35-year-old Medicare patient and reported abnormal findings (795.03, Papanicolaou smear of cervix with low grade squamous intraepithelial lesion [LGSIL]) in May 2010. She had a biopsy in June 2010 with a diagnosis of CIN I (622.11, Mild dysplasia of cervix), and a follow-up colposcopy in Dec. 2010, with a diagnosis of cervicitis (616.0, Cervicitis and endocervicitis). We received another Pap test for this patient in June 2011. How should we code this since it exceeds the two-year frequency for a screening Pap?

South Dakota Subscriber

Answer: You should bill the patient's Pap smear as a screening test for high-risk patients. Medicare covers high risk Paps annually, instead of once every two years.

Here's how: Instead of reporting screening Pap code V76.2 (Special screening for malignant neoplasms, cervix), you should report the Pap using V15.89 (Other specified personal history presenting hazards to health; other). You'll also need to append a secondary diagnosis assigned by the ordering physician that explains the high risk factor. Medicare considers patients high risk for any of the following situations:

• Engaged in sexual activity before the age of 16
• Had multiple sexual partners (more than five in a lifetime)
• Have a history of a sexually transmitted disease (including the human papillomavirus and/or HIV infection)
• Had fewer than three negative Pap tests within the previous seven years
• Daughter with diethylstilbestrol (DES) exposure
• Are of childbearing age and have had an examination that indicated the presence of cervical or vaginal cancer or other abnormalities during any of the preceding three years.

Based on the patient history, the physician will assign the secondary diagnosis to report abnormal biopsy findings and/or abnormal Pap results.

Once the patient has three normal Pap smears and/or no abnormal cervical or vaginal findings within the preceding three years, the physician should return to Pap screening every two years and order the test as V76.2.