Medicare Compliance & Reimbursement

Question: I am in a laboratory setting. For a patient whose thin-prep Pap test showed LGSIL, our lab performed low-risk and high-risk HPV DNA probe testing, with results positive for low risk and negative for high risk. What are the CPT and ICD-9 codes for the HPV testing?

Answer: The diagnosis code for ordering the human papillomavirus (HPV) tests is the Pap diagnosis 795.03 (Papanicolaou smear of cervix with low-grade squamous intraepithelial lesion [LGSIL]) because that is the Pap test results that you indicate.

Coverage issues: The American Society for Colposcopy and Cervical Pathology recommends HPV testing for Pap test results of atypical squamous cells of undetermined significance (ASC-US). For LGSIL, many payers indicate colposcopy as the next diagnostic step, not HPV testing. You should also check coverage rules about low-risk HPV testing because many payers will cover only the high-risk test.

With those caveats, here's how you should code the HPV testing and results:

The most common CPT code for HPV DNA testing from a thin-prep Pap specimen is 87621 (Infectious agent detection by nucleic acid [DNA or RNA]; papillomavirus, human, amplified probe technique). If your lab uses some other method, such as a direct probe technique, you should select the appropriate code that describes your procedure.

Because the results were positive for low-risk HPV, you should report the diagnosis as 795.09 (Other abnormal Papanicolaou smear of cervix and cervical HPV). In addition, you should indicate what the "other" HPV abnormality is by listing 079.4 (Viral and chlamydial infection in conditions classified elsewhere and of unspecified site; human papillomavirus).

Tip: You should not list the ICD-9 code that you are probably more familiar with for positive Pap/HPV test results, 795.05 (Cervical high-risk human papillomavirus [HPV] DNA test positive). Reserve 795.05 to report positive results of the high-risk HPV test.