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Family Practice Coding Alert

V72.31 Joins Medicare's List of Low-Risk Patient ICD-9 Codes

Reserve V72.31 for Pap during a gynecological exam You'll no longer have to use different Pap smear diagnosis codes on well-woman checks, thanks to Medicare's new addition of V72.31.

Starting July 1, 2005, you may use V72.31 (Routine gynecological examination) with Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory).

On claims for low-risk Medicare patients, Medicare carriers will now only accept V76.2 (Special screening for malignant neoplasms, cervix), which includes routine cervical Pap smear. Report All Well-Woman Paps With v72.31 Code V72.31 shouldn't be entirely new to you. Most commercial payers have always accepted this diagnosis code when a family physician performs a full gynecological examination.
 
In other words: You may use V72.31 for a routine gynecological examination with or without a Pap smear, regardless of insurer. "If Medicare wants us to use V72.31, then that's fine by me - as long as they get it right," says Christine Dubois, CPC, the coding coordinator and compliance office for Western Mass Physician Associates in Holyoke, Mass.

This ICD-9 code joins the other applicable diagnosis codes that Medicare will accept for low-risk patients:
  V76.2 - Special screening for malignant neoplasms, cervix

V76.47 - Special screening for malignant neoplasms, vagina
  V76.49 - Special screening for malignant neoplasms, other sites (Note: You should use this diagnosis for women without a cervix.) New way: You will be able to use V72.31 as another Medicare option provided the FP performs a full gynecological exam.

Re-Educate Staff on Single Diagnosis Code Although Medicare's new addition will initially require additional training, you will eventually enjoy streamlined ICD-9 coding.

On one hand, you may have a hard time re-educating your staff that they have another code out there to use. Coding clinics emphasize reporting V76.2, and now experts will have to change their advice.

But on the other hand, you now have the freedom to follow the exact rules commercial payers follow for a full gynecological exam. "We feel that V72.31 will be easier to use because the office staff are used to using that code for regular Paps" on non-Medicare claims, says Cathie Hays, RHIT, a coding and billing specialist at Sparta Community Hospital, Quality Healthcare Clinics in Sparta, Ill. Stick With G0101 and Q0091 Medicare's change in the well-woman-check diagnosis code does not affect the procedure codes you use. You should still report a:  breast and pelvic exam with G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination)
  Pap smear as Q0091
  preventive medicine service (such as 99387, Initial comprehensive preventive medicine evaluation and management of an individual ...; 99397, Periodic comprehensive preventive medicine re-evaluation and management of an individual ...) (Bill the patient, not your Medicare carrier, for this portion.) Remember: You can also report a [...]