Pathology/Lab Coding Alert

Question: Our lab has an ob-gyn client that orders a screening high risk HPV test as part of a wellness exam for all patients over 30. When the HPV test is positive, we report 795.05 as the diagnosis. The physician office let us know that the insurer pays for screening HPV, but when we report 795.05, the insurer applies the cost of the test to the patient's deductible. Should we use the ob-gyn's wellness exam code (V72.31) as the diagnosis code for the HPV test order?

Kansas Subscriber

Answer: No, you should not report V72.31 (Routine gynecological examination). Even if the insurer will cover a screening high risk HPV test, V72.31 is not the correct code to describe the screening. ICD-9 has a text note following V72.31 that states, "Use additional code to identify human papillomavirus (HPV) screening (V73.81)." If the physician orders HPV screening, you should report V73.81 (Special screening examination for human papillomavirus [HPV]) as the reason for the test.

You must report results: That said, you can't ignore the test results just because it might compromise the patient's deductible. If the high risk HPV test is positive, you must report 795.05 (Cervical high risk human papillomavirus [HPV] DNA test positive). You can still use V73.81 as the primary diagnosis and list the findings (795.05) as the secondary diagnosis.

Reflex test is different: Many payers won't cover screening HPV tests. Payers often cover high risk HPV testing when the patient's Pap test shows a diagnosis of 795.01 (Papanicolaou smear of cervix with atypical squamous cells of undetermined significance [ASCUS]).

When the physician orders high risk HPV testing in this scenario, the lab will "reflex" to an HPV test when the Pap test is 795.01. Based on the results, you have two diagnosis choices for the HPV test:

• 795.01 if the HPV test is negative
• 795.05 if the HPV test is positive.