Primary Care Coding Alert

Question: An FP performs a preventive medicine service and collects a Pap smear for cervical dysplasia cancer screening on a patient with low risk. Medicare is paying for the screening with V76.2, but private payers aren-t. Is there a different ICD-9 code we should use?

California Subscriber

Answer: Most private payers want V72.31 (Routine gynecological examination) with a screening Pap smear (Q0091, Screening Papanicolaou smear; obtaining, preparing, and conveyance of cervical or vaginal smear to laboratory; or 99000, Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory) that the physician performs with a preventive medicine service. V72.31 includes a general gynecological exam with or without a Pap smear.

Good news: You can use the same diagnosis for your carrier. Medicare started accepting V72.31 for collection of a screening Pap smear (Q0091) for dates of service on or after July 1, 2005. Prior to that date, Medicare required V76.2 (Special screening for malignant neoplasms; cervix), V76.47 (... vagina), or V76.49 (... other sites) for low-risk beneficiaries. Code V15.89 (Other specified personal history presenting hazards to health; other) with Q0091 denotes a high-risk beneficiary. Private payers have always used the V72.31 code instead with 99000.

For private payers, you should only use V76.2 when the only purpose of the visit is to collect a Pap smear from a low-risk patient.

Don't forget: Make sure to check the payers- frequency guidelines. Medicare allows a screening once every two years if the patient is low-risk. The American College of Obstetricians and Gynecologists (ACOG) recommends screenings every two to three years.