Pathology/Lab Coding Alert

Apply HCPCS Level II codes for Medicare reimbursement.

How will you ever choose the right Pap screening code when you have to maneuver dozens of coverage rules and procedure and diagnosis code choices?

Just follow our experts advice for a step-by-step plan to select the right code -- every time.

1: Identify Reason for the Test

Physicians order screening tests in the absence of signs or symptoms of disease. That means the patient has no current problems or past history of abnormal Pap results or cervical disease, explains Melanie Witt, RN, CPC, COBGC, MA, a coding expert based in Guadalupita, N.M.

For many patients, youll see V76.2 (Special screening for malignant neoplasms; cervix: routine cervical Papanicolaou smear) to explain the reason for the test, explains Sean Weiss, CPC, CPC-P, CMPE, CCA-P, CCP-P, senior partner at The CMC Group LLC in Atlanta.

The ordering physician might also use one of the following diagnosis codes to properly indicate that this is a screening Pap:

" V76.47 -- Special screening for malignant neoplasms, vagina

" V76.49 -- Special screening for malignant neoplasms, other sites.

Watch for post-hysterectomy Pap: When the physician orders a screening Pap smear for a patient without a cervix following a hysterectomy, use V76.47.

The physician might also report V88.01 (Acquired absence of both cervix and uterus), V88.02 (Acquired absence of uterus with remaining cervical stump), or V88.03 (Acquired absence of cervix with remaining uterus) to further describe the patients situation.

Some payers may require V76.49 instead of V76.47 for post-hysterectomy patients.

2: Choose the Right Screening Code

Many Pap test codes describe technical work, which is the actual slide preparation and review that a technician often performs. You choose the proper code based on the lab method (such as direct smear or liquid-based preparation), the screening/rescreening and manual/ automated options, and possibly the reporting system (such as Bethesda).

Caution: Dont let the words screening and rescreening in the definitions confuse you, Witt says. The terms refer to the examination and re-examination of the slides, not to the reason for the test.

Despite the fact that CPT provides 14 codes to describe the technical Pap service for a diagnostic or screening test (88142-88154, 88164-88167, and 88174-88175), Medicare requires you to report a screening Pap with a completely different set of codes found in HCPCS Level II. See Table 1: Medicare Pap Screening Codes and CPT Crosswalk on page 52 for a complete list of these codes.

3: Add Interpretation for Abnormal Smears

If the lab personnel reviewing the Pap slides identify anything abnormal  reactive or reparative cellular changes, atypical squamous or glandular cells of undetermined significance, or any cells in the premalignant or malignant category he lab will refer the slides to a pathologist, according to Witt.

The pathologist will perform a separate professional interpretation service in addition to the original technical Pap test service. Youll have to report an additional code for the pathologists interpretation.

For the interpretation of any abnormal Pap tests billed with a CPT code (diagnostic or non-Medicare screening),

you should report 88141 (Cytopathology, cervical or vaginal [any reporting system], requiring interpretation by physician).

For screening Medicare Pap tests, youll have to choose the appropriate HCPCS Level II professional interpretation code, which links to the technical Pap test code as follows:

" P3001 -Screening Papanicolaou smear, cervical or vaginal, up to 3 smears, requiring interpretation by physician (use with P3000)

" G0124 -Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician (use with G0123 or G0143-G0145)

" G0141 -Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician (use with G0147 and G0148).

Dont change diagnosis: If the physician ordered a screening test using a diagnosis code such as V76.2, you shouldnt change that code if the Pap test is abnormal. Instead, you should add the abnormality as a secondary diagnosis.

Reporting the secondary diagnosis is crucial to demonstrate medical necessity for further patient testing, Witt says.