Screening Pap Smears: Diagnoses Codes

30.6 - Screening Pap Smears: Diagnoses Codes (Rev. 11445, Issued:06-03-22 Effective:05-09-22, Implmentation:05-09-22) Effective October 1, 2015 the below are the current diagnoses that should be used when billing for screening Pap smear services The following chart lists the diagnosis codes that CWF must recognize for high-risk patients for every year screening Pap smear services. ICD-10-CM Codes for PAP High Risk every year ICD-10 CM code Definitions Z77.29 Contact with and (suspected) exposure to other hazardous substances Z72.51 High risk heterosexual behavior Z72.52 High risk homosexual behavior Z72.53 High risk bisexual behavior Z77.9 Other contact with and (suspected) exposures hazardous to health Z91.89 Other specified personal risk factors, not elsewhere classified Z92.850 Personal history of Chimeric Antigen Receptor T-cell therapy Z92.858 Personal history of other cellular therapy Z92.86 Personal history of gene therapy Z92.89 Personal history of other medical treatment The following chart lists the diagnosis codes that CWF must recognize for low-risk for every 2 years ICD-10-CM Codes for PAP Low Risk every 2 years ICD-10 CM code Definitions Z01.411 Encounter for gynecological examination (general) (routine) with abnormal findings Z01.419 Encounter for gynecological examination (general) (routine) without abnormal findings Z12.4 Encounter for screening for malignant neoplasm of cervix Z12.72 Encounter for screening for malignant neoplasm of vagina Z12.79 Encounter for screening for malignant neoplasm of other genitourinary organs Z12.89 Encounter for screening for malignant neoplasm of other sites A. Screening Pap Smears: Applicable Diagnoses for Billing A/B MAC (B) There are a number of appropriate diagnosis codes that can be used in billing for screening Pap smear services that the provider can list on the claim to give a true picture of the patient’s condition. Those diagnoses can be listed in Item 21 of Form CMS-1500 or the electronic equivalent (see Chapter 26 for electronic equivalent formats). In addition, one of the following diagnoses shall appear on the claim: the low-risk diagnosis of Z01.411, Z01.419, Z12.4, Z12.72, Z12.79, and Z12.89 or the high-risk diagnosis of, Z77.29, Z72.51, Z72.52, Z72.53, Z77.9, Z91.89, Z92.850, Z92.858, Z92.86, and Z92.89. (Effective Oct 1, 2015) One of the above diagnoses must be listed in item 21of the Form CMS-1500 or the electronic equivalent to indicate either low risk or high risk depending on the patient’s condition. Then either the low-risk or high-risk diagnosis must also be pointed to in Item 24E of Form CMS-1500 or the electronic equivalent. Providers must make sure that for screening Pap smears for a high-risk beneficiary that the high-risk diagnosis code appears in Item 21 that must be pointed to in Item 24E or the electronic equivalent. If Pap smear claims do not point to one of these specific diagnoses in Item 24E or the electronic equivalent, the claim will reject in the CWF. Periodically, A/B MACs (B) should do provider education on diagnosis coding of Pap smear claims. B. Screening Pap Smears: Applicable Diagnoses for Billing A/B MACs (A) Providers report one of the following diagnosis codes in Form CMS-1450 or the electronic equivalent (NOTE: Information regarding the form locator numbers that correspond to the diagnosis codes and a table to crosswalk its CMS-1450 form locator to the 837 transaction is found in Chapter 25.): Low-risk ICD-10-diagnosis codes for every 2 years: Z01.411 Encounter for gynecological examination (general) (routine) with abnormal findings Z01.419 Encounter for gynecological examination (general) (routine) without abnormal findings Z12.4 Encounter for screening for malignant neoplasm of cervix Z12.72 Encounter for screening for malignant neoplasm of vagina Z12.79 Encounter for screening for malignant neoplasm of other genitourinary organs Z12.89 Encounter for screening for malignant neoplasm of other sites High-risk ICD-10 diagnosis codes for every year: ICD-10 CM code Definitions Z77.29 Contact with and (suspected) exposure to other hazardous substances Z72.51 High risk heterosexual behavior Z72.52 High risk homosexual behavior Z72.53 High risk bisexual behavior Z77.9 Other contact with and (suspected) exposures hazardous to health Z91.89 Other specified personal risk factors, not elsewhere classified Z92.850 Personal history of Chimeric Antigen Receptor T-cell therapy Z92.858 Personal history of other cellular therapy Z92.86 Personal history of gene therapy Z92.89 Personal history of other medical treatment Periodically provider education should be done on diagnosis coding of Pap smear claims. C. HPV Screening: Applicable Diagnoses for Billing A/B MAC (A/B) Effective for claims with dates of service on or after July 9, 2015, providers shall report the following diagnosis codes when submitting claims for HCPCS G0476 - Cervical cancer screening, all-inclusive HPV co-test with cytology (Pap smear) to detect HPV DNA or RNA sequences: ICD-10: Z11.51, encounter for screening for HPV, and Z01.411, encounter for gynecological exam (general)(routine) with abnormal findings, OR, Z01.419, encounter for gynecological exam (general)(routine) without abnormal findings.