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Dx code 795.05

Vicki Posted Thu 24th of October, 2013 13:03:43 PM

I code for a pathology lab, recently we are getting denials when we bill "87621" with dx code "795.05" as service not covered with diagnosis and as provider responsibility, is this not the correct code to use when patient goes in for screening pap and patient has abnormal pap smear result and as a result of abnormal pap HPV testing is ordered?

SuperCoder Answered Thu 24th of October, 2013 17:36:02 PM

Labs commonly carry out the human papilloma virus (HPV) screen by amplified probe technique, and assuming that’s the method you use, you should code the initial high-risk HPV screen as 87621 (Infectious agent detection by nucleic acid (DNA or RNA); papillomavirus, human, amplified probe technique). When the results are positive and the lab subsequently uses the same technique for HPV typing for genotypes 16 and 18, report an additional unit of 87621.

Watch diagnoses: The patient’s record must demonstrate medical necessity for these tests. Typically Pap screens results such as 795.01 (Papanicolaou smear of cervix with atypical squamous cells of undetermined significance [ASCUS]) indicate the need for high-risk HPV screening. Similarly, you might expect a positive HPV screen, such as 795.05 (Cervical high risk human papillomavirus [HPV] DNA test positive) to demonstrate medical necessity for performing the HPV typing.

Typical high-risk HPV screening tests check for certain genotypes such as 16, 18, 31, 33, 35, 45, 51, 52, etc., which are associated with cervical lesions and cancer. A large number of cervical cancer cases may involve HPV type 16 (50-55 percent) or HPV type 18 (15-20 percent). Knowing the patient’s HPV 16 and 18 status may aid in patient prognosis, as well as evaluating the use of the HPV vaccine, which is derived from HPV types 16 and 18.

Check modifier: Some payers may want you to report the second 87621 with modifier 91 (Repeat clinical diagnostic laboratory test) rather than using units (87621 x 2).

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