Primary Care Coding Alert

Question: The family physician orders a screening Pap smear, as he suspects his patient may have been exposed to an STD. What would the diagnosis for this be?

New York Subscriber

Answer: Code V69.2 (High-risk sexual behavior) with secondary diagnosis of V15.89 (Other specified personal history presenting hazards to health; other). This may easily be confused with V74.5 (Special screening examination for bacterial and spirochetal diseases; venereal disease); however, considering that sexually transmitted disease (STD) infections are not entirely bacterial or spirochetal, using V74.5 might not be appropriate.

ICD-9-CM does not specify what "high risk" means  with respect to V69.2. However, Medicare lists several high risk factors for cervical and vaginal cancer that may be used as a guide in this regard. Those risk factors include:

• Early onset of sexual activity (under 16 years of age)

• Multiple sexual partners (five or more in a lifetime)

• History of sexually transmitted disease (including HIV infection)

• Fewer than three negative or any Pap smears within the previous seven years

• DES (diethylstilbestrol) -- exposed daughters of women who took DES during pregnancy.

In general, Medicare covers a screening pap smear and pelvic exam once every two years (meaning 24  months) for female beneficiaries at low risk. Women who are at high risk, as indicated by the factors noted above, or who 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, are eligible for a screening Pap smear and pelvic exam annually (meaning once every 12 months). (Refer to The Guide to Medicare Preventive Services, online at www.cms.hhs.gov/MLNProducts/downloads/mps_guide_web-061305.pdf ).