Avert Improper Denials for Interpretation of Pap Smears
Published on Fri Sep 01, 2000
Some pathologists are getting claim denials for interpretation of abnormal Pap smears (e.g., 88141) when a physician does not bill Pap test (e.g., 88164) as well. Dennis Padget, CPA, FHFMA, president of Padget & Associates, a pathology and laboratory financial consulting firm in Simpsonville, Ky. serving more than 150 clients in 25 states, says clients in many states are reporting denials.
Specifically quite a few insurers including some Medicare Part B carriers are denying CPT 88141 (cytopathology cervical or vaginal [any reporting system]; requiring interpretation by physician) P3001 (screening Papanicolaou smear cervical or vaginal up to three smears requiring interpretation by physician) and G0124 (screening cytopathology cervical or vaginal [any reporting system] collected in preservative fluid automated thin layer preparation requiring interpretation by physician) when billed without a screening Pap test code such as 88142 (cytopathology cervical or vaginal [any reporting system] collected in preservative fluid automated thin layer preparation; manual screening under physician supervision) 88164 (cytopathology slides cervical or vaginal [the Bethesda System]; manual screening under physician supervision) or P3000 (screening Papanicolaou smear cervical or vaginal up to three smears by technician under physician care) " reports Padget.
The confusion evidently stems from the CPT instruction to use 88141 in conjunction with cytopathology codes 88142-88154 and 88164-88167. Padget believes the offending insurers are reading the cited statement too literally" concluding that the American Medical Association (AMA) which authors the CPT always expects two codes to appear on one pathology claim. In other words these insurers and carriers are under the impression that CPT expects code 88141 to be paid only when accompanied by a Pap test code " states Padget.
In correspondence with Padget" however the AMA denied that the two services must be reported together. I have corresponded with the AMA for a definitive answer on what it means by in conjunction with when explaining in CPT how to bill for 88141 interpretation services says Padget. The AMAs response clarifies the meaning: The intent of the parenthetical statements concerning physician interpretation of Pap smears is not to imply that both services must be done by the same provider or facility. In conjunction with means simply that when a pathologist or facility performs both services " both codes are to be reported.
Diagnostic vs. Screening Pap Smears
To understand this scenario" coders must first be familiar with correct coding for Pap smears. Selecting the correct code depends on knowing if the reason for the test is screening or diagnostic as well as the lab methods used states Paula Richburg BS MHA director of laboratory services at QuadraMed Corp a leader in healthcare information technology in Bethlehem " Penn.
Medicare explicitly states that the code selection is always [...]
