Primary Care Coding Alert

Avoiding this Pap smear pitfall will prevent -outdated- code denials.

If you-re linking 17110 to a nonspecific code or reporting MRSA with 041.11, V09.0, your superbill needs a compliance check-up.

Verify your diagnosis charge sheet is compliant by answering these questions.

Question 1: Fill in the blank. Your physician evaluates a painful sore on a patient's foot, diagnoses a plantar wart, and removes it. The most specific ICD-9 code for this patient's condition is 078.____.

Answer 1: You should now code a diagnosis of plantar wart as 078.12 (Plantar wart). Prior to 078.12, providers and coders had to put plantar warts in with the other specified viral warts, 078.19 (Other specified viral warts), recalls Kris Cuddy,

CPC, billing education and coding specialist at Mid-Michigan Physicians, PC.

Benefit: "With 078.12, coders and physicians get a boost of appropriate, specific, and much needed coding ease," Cuddy says. Plantar warts are one of the most common viral warts destroyed in an office setting.

If you spot verruca plantaris in chart notes, equate this with plantar warts. The formal Latin term "verruca plantaris," which is an infection caused by human papilloma virus (HPV), has been moved from under 078.19 to under 078.12. For

destruction of plantar warts, which are benign tumors that occur on the sole, heel, or ball of the foot and most often in children and young adults between the ages of 12 and 16, you-ll use 17110 (Destruction [e.g., laser surgery, electrosurgery,

cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions) or 17111 .. 15 or more lesions) with 078.12.

Question 2: Your physician performed a vaginal Pap smear that showed atypical squamous cells of undetermined significance.

True or False? You should report 795.1 (Abnormal Papanicolaou smear of vagina and vaginal HPV) for this patient's condition.

Answer 2: False. If you report 795.1 (Abnormal Papanicolaou smear of vagina and vaginal HPV), your carrier will deny the claim. A fifth digit is needed, Cuddy says. "Look to 795.11 (Papanicolaou smear of vagina with atypical squamous cells of

undetermined significance [ASC-US])."

"In 2009, gynecological Pap smear coding gained ground with ten new, and two revised, Pap smear codes." Kuddy says. Plus, an entire new category (796.7, Abnormal cytologic smear of anus and anal HPV) for male or female Papanicolaou

smears of the anus.

Action plan: For accurate coding and specificity, if your FP office performs vaginal or anal Pap smears you should add all the new and revised codes, Cuddy recommends. These additions, which you can download from

www.cms.hhs.gov/ICD9ProviderDiagnoticCodes/07_summarytables.asp, span three categories. Here are some tips to get you started:

In category 795.0, use new code 795.07 (Satisfactory cervical smear but lacking transformation zone) to indicate a result where the transformation zone is not present in the specimen. "This is an important distinction," says Melanie Witt, RN,

CPC-OGS, MA, an independent coding consultant in Guadalupita, N.M. This transformation zone changes position in response to a woman's hormonal changes, Witt says. "A woman who is postmenopausal may have no endocervical cells in the

transformation zone, but the smear would still be considered satisfactory due to her status."

ICD-9 2009 revises category 795.1 (Abnormal Papanicolaou smear of vagina and vaginal HPV) and adds nine new codes that require an additional code to identify the acquired absence of uterus and cervix, if applicable (V88.01-V88.03).

Question 3: A patient has MRSA. To report the infection, should you use one or two ICD-9 codes?

Answer 3: One ICD-9 code is all you need to code a diagnosis of MRSA in 2009. You now have a streamlined way to report methicillin-resistant staphylococcus aureus (MRSA). To report MRSA, use one of the following ICD-9 codes:

- 038.12 ��" MRSA septicemia

- 041.12 ��" MRSA in conditions classified elsewhere and of unspecified site.

Old way: Because ICD-9 2008 contains no specific MRSA code to indicate the bacteria are meth-resistant, you had to use the infectious disease code 041.11 (Bacterial infection in conditions classified elsewhere and of unspecified site;

staphylococcus aureus) plus V09.0 (Infection with microorganisms resistant to penicillins). The resistance code isn't specific to MR or SA and isn't linked to the SA organism code (041.11), potentially skewing MRSA data, relayed Rebecca

Gomez, MD, MPH, with the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, in her proposal for MRSA specific codes. "National surveys contain a limited number of ICD-9 fields. Organism codes and

resistance codes may be deleted."

ICD-9 2009 will also revise the primary organism codes you currently use for MRSA to indicate methicillin-susceptible S. aureus (MSSA). Code 038.11 will refer to MSSA septicemia; and 041.11 will include MSSA "in conditions classified

elsewhere and of unspecified site."

Don't miss: You-ll also have two V codes for MRSA. To indicate a patient is a carrier or suspected carrier of MRSA, use V02.54. For personal history of MRSA, report V12.04.

Question 4: A father has just rejoined his family after a tour of duty in Iraq. He comes in with his wife and children to discuss the difficulties they are having adjusting to his homecoming. Which counseling V code should the FP circle:

D. V61.10

Answer 4: C. If your ICD-9 encounter sheet has a V code section for other services, consider including "Family Disruption V61.0x ." "The specific circumstances can affect how the physician may have to deal with the patient and

manage any ongoing medical problems," according to the ICD-9-CM Coordination and Maintenance Committee Meeting diagnosis agenda from March 19-20, 2008.

Space-saving tip: Leave off individually listing the V codes for the family disruptions. The physician can specify the type on the blank line, and the coder can look up of any of the V61.01 to V61.09 codes, which include disruption due to:

- family member on military deployment (V61.01)

- return of family member from military deployment (V61.02)

- divorce or legal separation-(V61.03)

- parent-child estrangement (V61.04)

- child in welfare custody (V61.05)

- child in foster care or in care of non-parental family member (V61.06)

- other family disruption (V61.09).