Add ICD-10-CM Accuracy to Your Repeat Pap Smear Claims

Fri, Jul 28, 2017 --

ICD-10, Skill Sharpener

Right about now it feels like all eyes are on ICD-10-CM 2018 (and there are plenty of changes to deal with). But we’ve got to be sure codes for our current claims are accurate, too. Today let’s get back to basics with a look at how to handle diagnosis coding for repeat Pap smears.

Zero In on R87.61- Subcategory

When the provider repeats a Pap smear because of an inadequate sample or abnormal results, you’ll report a code from R87.61- (Abnormal cytological findings in specimens from cervix uteri).

The required sixth character lets you give more details:

  • R87.610, Atypical squamous cells of undetermined significance on cytologic smear of cervix (ASC-US)
  • R87.611, Atypical squamous cells cannot exclude high grade squamous intraepithelial lesion on cytologic smear of cervix (ASC-H)
  • R87.612, Low grade squamous intraepithelial lesion on cytologic smear of cervix (LGSIL)
  • R87.613, High grade squamous intraepithelial lesion on cytologic smear of cervix (HGSIL)
  • R87.614, Cytologic evidence of malignancy on smear of cervix
  • R87.615, Unsatisfactory cytologic smear of cervix
  • R87.616, Satisfactory cervical smear but lacking transformation zone
  • R87.618, Other abnormal cytological findings on specimens from cervix uteri
  • R87.619, Unspecified abnormal cytological findings in specimens from cervix uteri.

Tip: Use R87.619 when your documentation matches these terms:

  • Abnormal cervical cytology NOS
  • Abnormal Papanicolaou smear of cervix NOS
  • Abnormal thin preparation smear of cervix NOS
  • Atypical endocervial cells of cervix NOS
  • Atypical endometrial cells of cervix NOS
  • Atypical glandular cells of cervix NOS.

Look Elsewhere for These Diagnoses

There’s an impressive list of Excludes1 and Excludes2 notes at the R87.61- level, meaning the list applies to all of the codes in that subcategory.

When you’re reviewing the notes, keep in mind what each type of Excludes note means. According to the 2017 Official Guidelines, Excludes1 is the stricter of the two notes, generally meaning the excluded code should never be reported at the same time as the code with the note. But there is an exception. If the two conditions are unrelated, you may report both codes together. An Excludes2 note indicates the code doesn’t represent the excluded condition, but if the patient has both conditions you may report both codes.

Here is what you will find listed with R87.61-:

Excludes1:

  • Abnormal cytological findings in specimens from other female genital organs (R87.69)
  • Abnormal cytological findings in specimens from vagina (R87.62-)
  • Carcinoma in situ of cervix uteri (histologically confirmed) (D06.-)
  • Cervical intraepithelial neoplasia I [CIN I] (N87.0)
  • Cervical intraepithelial neoplasia II [CIN II] (N87.1)
  • Cervical intraepithelial neoplasia III [CIN III] (D06.-)
  • Dysplasia (mild) (moderate) of cervix uteri (histologically confirmed) (N87.-)
  • Severe dysplasia of cervix uteri (histologically confirmed) (D06.-)

Excludes2:

  • Cervical high risk human papillomavirus (HPV) DNA test positive (R87.810)
  • Cervical low risk human papillomavirus (HPV) DNA test positive (R87.820)

Know Which Code to Use for Inadequate Sample

Subcategory R87.61- has a lot of codes, so don’t miss two slightly different ones in the middle:

  • R87.615, Unsatisfactory cytologic smear of cervix
  • R87.616, Satisfactory cervical smear but lacking transformation zone.

ICD-10 states R87.615 is appropriate for “inadequate sample of cytologic smear of cervix.”

Medicare tip: Experts advise using the appropriate Z code, such as Z12.4 (Encounter for screening for malignant neoplasm of cervix), when reporting these repeat Pap smears to Medicare.

What About You?

What challenges have you encountered when choosing ICD-10-CM codes related to Pap smears?

About 

Deborah concentrates on coding and compliance for radiology and cardiology, including the tricky world of interventional procedures, as well as oncology and hematology. Since joining The Coding Institute in 2004, she’s also covered the ins and outs of coding for orthopedics, audiology, skilled nursing facilities (SNFs), and more.

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