Pathology/Lab Coding Alert

Question: When we bill for a screening Pap for a post-hysterectomy patient, we've found that some insurers won't cover the test when we list the ordering diagnosis as V76.47. Should we use V76.2 instead, even though the patient doesn't have a cervix?

New Hampshire Subscriber

Answer: No, you should not list V76.2 (Screening for malignant neoplasms of the cervix) for a screening Pap test for a post-hysterectomy patient. As you indicate, the patient doesn't have a cervix, so V76.2 is incorrect.

When you report V76.47 (Special screening for malignant neoplasms vagina), ICD-9 instructs you to "use additional code to identify acquired absence of uterus." That means you should list one of the following codes in addition to V76.47:

• V88.01 -- Acquired absence of both cervix and uterus
• V88.02 -- Acquired absence of uterus with remaining cervical stump
• V88.03 -- Acquired absence of cervix with remaining uterus

If you're not documenting acquired absence of cervix, that might be the reason you're getting denials.

Some payers, however, don't want you to use V76.47 for a post-hysterectomy screening Pap. Because ICD-9 describes V76.47 as "vaginal pap smear status-post-hysterectomy for non-malignant condition," some payers claim that this code indicates a diagnostic Pap rather than a preventive screening. These payers may also reserve V67.01 (Following surgery follow-up vaginal Pap smear) for diagnostic Paps following hysterectomy for malignancy. ICD-9 describes V67.01 as "vaginal Pap smear status-post hysterectomy for malignant condition."

Option: Some payers want you to order screening Pap smears post-hysterectomy using V76.49 (Special screening for malignant neoplasms other sites) instead of V76.47.

Bottom line: You should contact the payers who deny the screening Pap charge for post-hysterectomy patients and ask which diagnosis code(s) they want physicians to use, in that scenario.