Collect HPV Pay with Proper Screening vs. Reflex Diagnoses

Posted on 10. Jun, 2010 by Editor.

Align ‘medical necessity’ with ICD-9 instruction.

Ordering a human papillomavirus (HPV) screen with a Pap test isn’t the same as ordering a reflex HPV screen following an abnormal Pap. Although ICD-9 instruction and coverage rules might appear to be at loggerheads, our experts can show you the way out.

Question: Should the physician order a screening and/or reflex HPV Pap test (such as 87621, Infectious agent detection by nucleic acid [DNA or RNA]; papillomavirus, human, amplified probe technique) with V73.81 (Special screening examination for human papillomavirus [HPV])?

What you stand to gain: “Many ‘V’ codes are paid as part of a screening benefit for patients who have those specific benefits,” says Tina Burkhalter, billing manager with SouthEastern Pathology in Rome, Ga. On the other hand,

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Pregnancy Global Coding Guide: 59400, 59510, 59610 & 59618 Tips

Posted on 29. Jul, 2009 by .

Good news: You can report a higher-level (and higher-paying) E/M in this annual-visit situation.

Annual visits often lead to confusion when it comes to establishing a patient’s pregnancy. Take this 3-part challenge by deciding if the ob-gyn package begins based on these scenarios:

• a patient’s annual visit leads to a diagnosis of her pregnancy,

• she arrives knowing that she is pregnant, or

• the ob-gyn eliminates other possible diagnoses.

Hint: In the majority of circumstances, you should not begin counting antepartum visits for the global maternity codes (59400, 59510, 59610, 59618) until the next full visit, coding experts say.

AUDIO: The #1 mistake providers make when choosing the level of antepartum service. Melanie Witt shows you how to fix it for good.

Still Report Annual When Visit Leads to Pregnancy Dx

Scenario 1: If the ob-gyn diagnoses pregnancy (V72.42, Pregnancy examination or test, positive result) during a patient’s annual exam (99384-99386 for new patients, or 99394-99396 for established patients), you can still report the annual examination, as long as you link the pregnancy diagnosis to the diagnostic test (for instance, 81025, Urine pregnancy test, by visual color comparison methods).

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