Primary Care Coding Alert

Question: I have a family physician who does HPV testing whenever she does a Pap smear, unless the patient says that she already had the screening done. Is the HPV test included in the Pap? If I can separately report the HPV, what ICD-9 codes should I use?

Kentucky Subscriber

Answer: A human papillomavirus (HPV) test is not part of the screening Pap smear. Although both tests screen for cervical cancer, the HPV test is more specific, checking only genetic evidence for the presence of HPV. Current recommendations don't include doing an HPV test together with the Pap smear. In addition, the United States Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against the routine use of HPV testing as a primary screening test for cervical cancer. The agency found poor evidence to determine the benefits and potential harms of HPV screening as an adjunct or alternative to regular Pap smear screening.

HPV tests can be ordered after a screening Pap smear test with abnormal results, especially if the Pap test showed abnormal cervical cells. In this scenario, use V73.81 (Special screening examination for viral and chlamydial diseases; other specified viral and chlamydial diseases; human papillomavirus [HPV]).

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, 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).