LCD for Diagnostic Pap Smear (L22842)

All ICD-9 Codes (diagnosis codes) must be carried to their highest level of specification.

ICD-9 Codes that Support Medical Necessity

054.10 GENITAL HERPES UNSPECIFIED 054.11 HERPETIC VULVOVAGINITIS 054.12 HERPETIC ULCERATION OF VULVA 078.0 MOLLUSCUM CONTAGIOSUM 078.10 VIRAL WARTS UNSPECIFIED 078.11 CONDYLOMA ACUMINATUM 078.19 OTHER SPECIFIED VIRAL WARTS 090.0 - EARLY CONGENITAL SYPHILIS SYMPTOMATIC - VENEREAL DISEASE 099.9 UNSPECIFIED 112.1 CANDIDIASIS OF VULVA AND VAGINA 112.2 CANDIDIASIS OF OTHER UROGENITAL SITES 171.6 MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE OF PELVIS 179 MALIGNANT NEOPLASM OF -PART UNS 180.0 - MALIGNANT NEOPLASM OF ENDOCERVIX - MALIGNANT NEOPLASM OF 180.9 UTERI UNSPECIFIED SITE 181 MALIGNANT NEOPLASM OF PLACENTA 182.0 - MALIGNANT NEOPLASM OF CORPUS UTERI EXCEPT ISTHMUS - 182.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF BODY OF UTERUS 183.0 - MALIGNANT NEOPLASM OF - MALIGNANT NEOPLASM OF 183.8 OTHER SPECIFIED SITES OF UTERINE ADNEXA 184.0 - MALIGNANT NEOPLASM OF VAGINA - MALIGNANT NEOPLASM OF 184.9 FEMALE GENITAL ORGAN SITE UNSPECIFIED 195.3 MALIGNANT NEOPLASM OF PELVIS 198.6 SECONDARY MALIGNANT NEOPLASM OF OVARY 198.82 SECONDARY MALIGNANT NEOPLASM OF GENITAL ORGANS 218.0 - SUBMUCOUS LEIOMYOMA OF UTERUS - LEIOMYOMA OF UTERUS 218.9 UNSPECIFIED 219.0 - BENIGN NEOPLASM OF CERVIX UTERI - BENIGN NEOPLASM OF 219.9 UTERUS PART UNSPECIFIED 220 BENIGN NEOPLASM OF OVARY 221.0 - BENIGN NEOPLASM OF AND UTERINE LIGAMENTS - 221.9 BENIGN NEOPLASM OF FEMALE GENITAL ORGAN SITE UNSPECIFIED 233.1 - CARCINOMA IN SITU OF CERVIX UTERI - CARCINOMA IN SITU OF 233.2 OTHER AND UNSPECIFIED PARTS OF UTERUS 233.30 CARCINOMA IN SITU, UNSPECIFIED FEMALE GENITAL ORGAN 233.31 CARCINOMA IN SITU, VAGINA 233.39 CARCINOMA IN SITU, OTHER FEMALE GENITAL ORGAN 233.9 CARCINOMA IN SITU OF OTHER AND UNSPECIFIED URINARY ORGANS 236.0 - NEOPLASM OF UNCERTAIN BEHAVIOR OF UTERUS - NEOPLASM OF 236.3 UNCERTAIN BEHAVIOR OF OTHER AND UNSPECIFIED FEMALE GENITAL ORGANS 256.0 - HYPERESTROGENISM - UNSPECIFIED OVARIAN DYSFUNCTION 256.9 616.0 AND ENDOCERVICITIS 616.10 - AND VULVOVAGINITIS UNSPECIFIED - VAGINITIS AND 616.11 VULVOVAGINITIS IN DISEASES CLASSIFIED ELSEWHERE 616.2 CYST OF BARTHOLIN'S GLAND 616.50 - ULCERATION OF VULVA UNSPECIFIED - ULCERATION OF VULVA IN 616.51 DISEASES CLASSIFIED ELSEWHERE 616.81 MUCOSITIS (ULCERATIVE) OF CERVIX, VAGINA, AND VULVA 616.89 OTHER INFLAMMATORY DISEASE OF CERVIX, VAGINA AND VULVA 616.9 UNSPECIFIED INFLAMMATORY DISEASE OF CERVIX VAGINA AND VULVA 617.0 - OF UTERUS - ENDOMETRIOSIS SITE UNSPECIFIED 617.9 620.0 FOLLICULAR CYST OF OVARY 620.1 OR HEMATOMA 620.2 OTHER AND UNSPECIFIED 620.8 OTHER NONINFLAMMATORY DISORDERS OF OVARY FALLOPIAN TUBE AND BROAD LIGAMENT 621.0 POLYP OF CORPUS UTERI 621.1 CHRONIC SUBINVOLUTION OF UTERUS 621.2 HYPERTROPHY OF UTERUS 621.8 OTHER SPECIFIED DISORDERS OF UTERUS NOT ELSEWHERE CLASSIFIED 622.0 EROSION AND ECTROPION OF CERVIX 622.10 DYSPLASIA OF CERVIX, UNSPECIFIED 622.11 MILD DYSPLASIA OF CERVIX 622.12 MODERATE DYSPLASIA OF CERVIX 622.7 MUCOUS POLYP OF CERVIX 622.8 OTHER SPECIFIED NONINFLAMMATORY DISORDERS OF CERVIX 622.9 UNSPECIFIED NONINFLAMMATORY DISORDER OF CERVIX 623.0 DYSPLASIA OF VAGINA 623.5 NOT SPECIFIED AS INFECTIVE 623.7 POLYP OF VAGINA 623.8 OTHER SPECIFIED NONINFLAMMATORY DISORDERS OF VAGINA 623.9 UNSPECIFIED NONINFLAMMATORY DISORDER OF VAGINA 624.6 POLYP OF LABIA AND VULVA 624.8 OTHER SPECIFIED NONINFLAMMATORY DISORDERS OF VULVA AND PERINEUM 625.70 , UNSPECIFIED 625.71 VULVAR VESTIBULITIS 625.79 OTHER VULVODYNIA 626.2 EXCESSIVE OR FREQUENT MENSTRUATION 626.6 METRORRHAGIA 626.7 626.8 OTHER DISORDERS OF MENSTRUATION AND OTHER ABNORMAL BLEEDING FROM FEMALE GENITAL TRACT 626.9 UNSPECIFIED DISORDERS OF MENSTRUATION AND OTHER ABNORMAL BLEEDING FROM FEMALE GENITAL TRACT 627.1 POSTMENOPAUSAL BLEEDING 627.2 SYMPTOMATIC MENOPAUSAL OR FEMALE CLIMACTERIC STATES 627.3 POSTMENOPAUSAL 627.8 OTHER SPECIFIED MENOPAUSAL AND POSTMENOPAUSAL DISORDERS 627.9 UNSPECIFIED MENOPAUSAL AND POSTMENOPAUSAL DISORDER 628.0 - FEMALE ASSOCIATED WITH - 628.9 INFERTILITY FEMALE OF UNSPECIFIED ORIGIN 649.70 CERVICAL SHORTENING, UNSPECIFIED AS TO EPISODE OF CARE OR NOT APPLICABLE 649.71 CERVICAL SHORTENING, DELIVERED, WITH OR WITHOUT MENTION OF ANTEPARTUM CONDITION 649.73 CERVICAL SHORTENING, ANTEPARTUM CONDITION OR COMPLICATION

654.10 - TUMORS OF BODY OF UTERUS UNSPECIFIED AS TO EPISODE OF 654.14 CARE IN PREGNANCY - TUMORS OF BODY OF UTERUS POSTPARTUM CONDITION OR COMPLICATION 795.00 ABNORMAL GLANDULAR PAPANICOLAOU SMEAR OF CERVIX 795.01 PAPANICOLAOU SMEAR OF CERVIX WITH ATYPICAL SQUAMOUS CELLS OF UNDETERMINED SIGNIFICANCE (ASC-US) 795.02 PAPANICOLAOU SMEAR OF CERVIX WITH ATYPICAL SQUAMOUS CELLS CANNOT EXCLUDE HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESION (ASC-H) 795.03 PAPANICOLAOU SMEAR OF CERVIX WITH LOW GRADE SQUAMOUS INTRAEPITHELIAL LESION (LGSIL) 795.04 PAPANICOLAOU SMEAR OF CERVIX WITH HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESION (HGSIL) 795.05 CERVICAL HIGH RISK HUMAN PAPILLOMAVIRUS (HPV) DNA TEST POSITIVE 795.06 PAPANICOLAOU SMEAR OF CERVIX WITH CYTOLOGIC EVIDENCE OF MALIGNANCY 795.07 SATISFACTORY CERVICAL SMEAR BUT LACKING TRANSFORMATION ZONE 795.08 UNSATISFACTORY CERVICAL CYTOLOGY SMEAR 795.09 OTHER ABNORMAL PAPANICOLAOU SMEAR OF CERVIX AND CERVICAL HPV 795.10 ABNORMAL GLANDULAR PAPANICOLAOU SMEAR OF VAGINA 795.11 PAPANICOLAOU SMEAR OF VAGINA WITH ATYPICAL SQUAMOUS CELLS OF UNDETERMINED SIGNIFICANCE (ASC-US) 795.12 PAPANICOLAOU SMEAR OF VAGINA WITH ATYPICAL SQUAMOUS CELLS CANNOT EXCLUDE HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESION (ASC-H) 795.13 PAPANICOLAOU SMEAR OF VAGINA WITH LOW GRADE SQUAMOUS INTRAEPITHELIAL LESION (LGSIL) 795.14 PAPANICOLAOU SMEAR OF VAGINA WITH HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESION (HGSIL) 795.15 VAGINAL HIGH RISK HUMAN PAPILLOMAVIRUS (HPV) DNA TEST POSITIVE 795.16 PAPANICOLAOU SMEAR OF VAGINA WITH CYTOLOGIC EVIDENCE OF MALIGNANCY 795.18 UNSATISFACTORY VAGINAL CYTOLOGY SMEAR 795.19 OTHER ABNORMAL PAPANICOLAOU SMEAR OF VAGINA AND VAGINAL HPV