Ladies First Provider Newsletter
March 2017
Vaginal bleeding              Fee Schedule              HPV Vaccine              Genotyping              Education  
EvaluationEvaluation of the cervix in patients with abnormal vaginal bleeding
ASCCP Clinical Practice Statement February 7, 2017

All women presenting with abnormal vaginal bleeding should receive evaluation of the cervix and vagina, which should include at minimum visual inspection (speculum exam) and palpation (bimanual exam). If cervical or vaginal lesions are noted, appropriate tissue sampling is recommended, which can include Pap testing in addition to biopsy with or without colposcopy. These recommendations concur with those of ACOG Practice Bulletin #128 and Committee Opinion #557.1,2. The purpose of this article is to remind clinicians that Pap testing, as a form of tissue sampling, can be an important part of the workup of abnormal bleeding, and can be performed even if the patient is not due for her next screening test if there is clinical concern for cancer.   
FeesLadies First Fee Schedule Released
2017 Changes
The Ladies First 2017 fee schedule has been released. There have been several changes. Mammogram codes 77055, 77056, and 77057 have been removed. Ladies First will still pay for mammogram codes G0202, G0204, and G0206 as well as new mammogram codes 77065, 77066, and 77067.

While Ladies First screening visits are best represented by using office visit codes in the 992xx series, codes 99385, 99386, 99395, and 99396 have been added. It is important to keep in mind that Ladies First can only pay for the services and blood testing that is outlined in the fee schedule. Ladies First cannot pay for TSH testing, STD testing, Colonoscopies, or Bone Density Scanning. Ladies First urges providers to discuss with Ladies First members the potential charges that come with testing and procedures that are not covered by Ladies First.

Don't see a diagnosis code on our list? Call the Ladies First billing specialist at
800-508-2222 for claim review and possible manual payment. 

VaccineHPV Vaccine
Effective cancer prevention
The human papilloma virus (HPV) causes most cervical cancers, as well as cancers of the vagina, vulva, penis, anus, rectum, and oropharynx (cancers of the back of the throat, including the base of the tongue and tonsils).  Oropharyngeal cancer is the most common HPV related cancer in men, while cervical cancer is the most common HPV related cancer in women. The HPV vaccine can effectively prevent a majority of HPV infections and related cancers.
HPV vaccines are recommended for all adolescents, beginning at age 11-12. The vaccine may be given between the ages of 9-26 years, but research has shown that it is more effective when given earlier.  When given before the age of 15,  two doses of HPV vaccine are recommended six months apart. For those who start the vaccine after age 15 or are immunosuppressed, three doses of HPV vaccine are recommended.
Christine Finley, Immunization Program Manager notes "The HPV vaccine is safe and effective in preventing six cancers, but only if parents make sure to have their teens vaccinated." The Immunization Program provides HPV vaccines to all providers enrolled in the Vaccines for Children (VFC) program  at no cost. 
Answers to common questions on  HPV vaccination  are on the Health Department website.

GenotypingNormal Pap smear and positive HPV ?
When to perform HPV genotyping
There are two options for women age 30+. 1. Wait a year and repeat both tests. If the high risk HPV test is still positive, provider might recommend a colposcopy OR  2. Perform HPV genotyping CPT 87625 for HPV 16 or 18 now. If the HPV genotyping test is positive for HPV 16 or 18, the provider might recommend a colposcopy. If the HPV genotyping test is negative for HPV 16 and 18, the provider can wait 12 months and then repeat a Pap test and HPV test (NOT genotyping). 

EducationNew! Health Care Provider Education
Learn how to help young women lower their risk for early breast cancer
The Centers for Disease Control (CDC) is initiating the "Bring Your Brave" campaign to educate young women and health care providers about early onset breast cancer and hereditary breast and ovarian cancer risk. According to national data, only 28.7% of primary care physicians refer a woman with average risk to genetic counseling, and 41.1% refer a woman wi th high risk for genetic counseling or testing, indicating a knowledge and efficacy gap in appropriate genetic risk detection. Below, learn more about factors that place women at risk for early-onset breast and ovarian cancer, strategies to improve communication with younger women at increased risk and clinically validated tools for assessing risk for breast cancer.

Learn more here >>
Timely information from Ladies First!