Part B Insider (Multispecialty) Coding Alert

Question: I’m trying to select the proper code for the thin-prep Pap tests that our lab does, but I’m having a hard time choosing the correct code. Can you explain the difference between 88142 and 88175?

Answer: The difference between the two codes you mention is in the screening process, or how the lab personnel review the slide for abnormalities. The basic difference is whether the Pap slide review involves a computer-assisted evaluation and review by a cytotechnologist, or just evaluation by a cytotechnologist.   

Each of the codes you asked about is part of a larger family, so let’s look at the two code families to understand the differences, as follows:

• 88142 — Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision
  
• 88143 — ... with manual screening and rescreening under physician supervision
  
• 88174 — ... screening by automated system, under physician supervision
  
• 88175 — ... with screening by automated system and manual rescreening or review, under physician supervision.
  

Both code families describe thin-prep, or liquid-based, Pap tests under physician supervision. The key difference is that the 88142 family involves an initial “manual” slide screening, meaning that a cytotechnologist evaluates the slides for abnormalities. On the other hand, the 88174 family involves an initial “screening by automated system,” meaning that a computer evaluates the slides for abnormalities. 

More similarities: Both code families also provide two codes: the first for a screening without a re-screening step, and the second code that includes a manual re-screening step. 

Caution: If you’re billing Medicare for a Pap test, you shouldn’t use any of the preceding codes. Instead, for a thin-prep test, you’ll need to choose the appropriate HCPCS Level II code, such as G0123 (...screening by cytotechnologist under physician supervision).