Ob-Gyn Coding Alert

Question: As part of the annual ob/gyn exams in the office, we do a Pap and send it to our pathologist for interpretation/reading. I bill 88150 (cytopathology, slides, cervical or vaginal; manual screening under physician supervision) but get denied and told that the procedure requires a valid Clinical Laboratory Improvement Amendments (CLIA) ID number. What am I doing wrong?

Wyoming Subscriber

 
Answer: Code 88150 is to be used by the lab that did the interpretation, unless you pay the lab up front and are billing on its behalf. In that case you must add modifier-90 (reference [outside] laboratory) to the code. Code 88150 requires a CLIA ID, showing that your office has applied for and been granted a license to perform high-complexity lab tests, which is not likely the case here. If you are trying to bill for Pap handling, use 99000 (handling and/or conveyance of specimen for transfer from the physician's office to a laboratory), or Q0091 (screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) if it is a Medicare patient. With the one exception under the Medicare program, collecting the specimen is part of the exam and should not be billed separately. Also note that some payers will not reimburse a handling fee for the Pap smear.