Ob-Gyn Coding Alert

Question: One of my physicians told me to bill 88141 with 88164. We send our Pap collections to a pathology lab where they are read. Can I bill for both of these codes?

Maine Subscriber

Answer: Code 88141 (cytopathology, cervical or vaginal [any reporting system]; requiring interpretation by physician [list separately in addition to code for technical service]) is used by the pathologist who interprets the slide, not by the physician who ordered it. Reviewing the Pap results is part of the medical decision-making during the E/M service and is not billable separately.
 
Code 88164 (cytopathology, slides, cervical or vaginal [the Bethesda system]; manual screening under physician supervision) is a billable test service on the same day as the E/M or other service, but only if you either have a CLIA certificate that permits you to bill for a lab service that is defined as complex or if you are billing on behalf of the laboratory for this interpretation. In the latter case, you could bill for both of these codes, but you need to add modifier -90 (reference [outside] laboratory) to indicate that a reference lab performed the service. You should note, however, that Medicare would not allow you to bill in this fashion.
 
If you bill for the collection and handling of the specimen for a non-Medicare patient and use these codes, the correct code is 99000 (handling and/or conveyance of specimen for transfer from the physician's office to a laboratory). Some payers reimburse for the collection, and others include it as part of the E/M or preventive service.

-- Answers to You Be the Coder and Reader Questions provided by Melanie Witt, RN, CPC, MA, an independent coding consultant and ob/gyn coding expert