Pathology/Lab Coding Alert

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 based on the reason the test was performed" regardless of the results of the test (Health Care Financing Administration [HCFA] program memorandum AB-98-71). Padget adds " HCFA is adamant that the reason the test was performed must be stipulated by the referring physician. The laboratory performing the test is not supposed to make even an educated guess or assumption in this regard.

The answer to the screening or diagnostic question will lead you to two different groups of codes" " explains Richburg. Pap smears conducted by the same method and reporting system will have a different code depending on the purpose for the test.

1. Screening codes: Screening Pap smears are those performed in the absence of signs or symptoms of disease and are reported using HCPCS codes. HCPCS codes also are used with screening smears that the referring physician attributes to a patient whos considered high risk. Medicare defines a high-risk patient as one whos had early onset of sexual activity" a history of sexually transmitted disease " and fewer than three negative Pap tests in the previous seven years.

Use the screening HCPCS Pap test codes as follows:

P3000 to report any conventionally prepared Pap smear that initially goes through a manual screening process. Report this code regardless of the rescreening or reporting system.

G0147- G0148 to report any conventionally prepared Pap smear that initially goes through an automated screening process. The difference in the codes involves the manual or automated rescreening.

HCPCS has a series of codes for screening Pap smears processed by thin-layer preparation" depending on the method of screening and rescreening " says Richburg. These HCPCS codes are:

G0123 (screening cytopathology" cervical or vaginal [any reporting system] collected in preservative fluid automated thin layer preparation " screening by cytotechnologist under physician supervision)

G0143 (screening cytopathology" cervical or vaginal [any reporting system] " collected in preservative fluid" automated thin layer preparation " with manual screening and rescreening by cytotechnologist under physician supervision)

G0144 (screening cytopathology" cervical or vaginal [any reporting system] " collected in preservative fluid" automated thin layer preparation " with anual screening and computer-assisted rescreening by cytotechnologist under physician supervision)

G0145 (screening cytopathology" cervical or vaginal [any reporting system] " collected in preservative fluid" automated thin layer preparation " with manual screening and computer-assisted rescreening using cell selection and review under physician supervision)

For an in-depth description of these codes and how they are used" see How a Lab Can Avoid Medicare Denials for Pap Smears in the April 2000 Pathology/Lab Coding Alert on page 25. Remember " only the federal Medicare program requires HCPCS codes; state Medicaid programs and private insurers use CPT codes exclusively.

2. Diagnostic codes: Medicare covers diagnostic Pap smears for a number of reasons that represent signs and symptoms of disease" advises Richburg. These include previous cancer or other abnormal findings of the cervix uterus or vagina " previous abnormal Pap smear or any other finding that the physician judges to be related to a gynecological disorder.

All diagnostic Pap smears should be coded with the appropriate a href="https://www.aapc.com/codify/ama-cpt-assistant.aspx">CPT procedural codesPathology/Lab Coding Alert on page 6.

Pathologists Interpretation of Pap Smears

Any of these Pap tests (P3000" G0123 G0143-G0145 G0147-G0148 88142-88154 " and 88164-88167) may result in a suspect or abnormal Pap smear that must be interpreted by a pathologist. This interpretation service is being denied by many payers when it is not reported in conjunction with one of the Pap test codes.

There are four codes recognized by Medicare for the pathologists interpretation of a suspect or abnormal Pap test" " each to be used under different circumstances.

Use 88141 (cytopathology" " cervical or vaginal [any reporting system]; requiring interpretation by physician [list separately in addition to code for technical service]) for the interpretation of any suspect or abnormal diagnostic Pap test that is described by any of the codes 88142-88154 or 88164-88167.

Use P3001 (screening Papanicolaou smear" cervical or vaginal up to three smears requiring interpretation by physician) for the interpretation of any suspect or abnormal screening Pap test that is reported by codes P3000 or G0147. Also use P3001 for any physician interpretation of a screening Pap smear for which the method of specimen preparation evaluation and reporting system are not specified. Effective Jan. 1 1999 P3001 became a professional code only and is no longer reported with modifiers -TC (technical component) and -26 (professional component) " according to HCFA program memorandum AB-98-71.

Use G0141 (screening cytopathology smears" cervical or vaginal performed by automated system with manual rescreening " requiring interpretation by physician) for the physician interpretation of the screening Pap test described by code G0148.

Use G0124 (screening cytopathology" cervical or vaginal [any reporting system] collected in preservative fluid automated thin layer preparation " requiring interpretation by physician) to report the physician interpretation of suspect or abnormal screening Pap tests conducted using thin layer preparation methods. These are codes G0123 and G0143-G0145.

Pap Tests and Interpretation Reported Together?

Of course" many pathologists have an arrangement with a hospital or an independent laboratory allowing the physician to bill for interpreting abnormal and suspect Pap tests (88141 P3001 G0141 G0124) states Padget. But the hospital or independent laboratory that employs the cytotechnologist bills for the Pap test itself (e.g. 88142 " P3000).

In these cases" The pathologist may very well not even be entitled to bill for the cytotechnologist services says Padget. Yet the pathologists professional fees are being denied due to an obvious misreading of the CPT text by some insurers and Medicare Part B carriers. These payers are evidently misinterpreting the CPT direction to use 88141 in conjunction with codes 88142-88154 88164-88167. They are taking it to mean that the AMA expects physician interpretation code 88141 to be billed by the same provider who is billing the applicable code for the Pap test " Padget explains.

As a result" some payers have set up claim processing edits to deny code 88141 unless it is accompanied by a Pap test code (88142-88145 or 88164-88167) with the same date of service billed by the same entity reports Padget. Similarly denials have occurred for the HCPCS pathologist interpretation codes (P3001 G0141 G0124) when not accompanied by the appropriate HCPCS Pap screening code (P3000 G0147-G0148 G0123 " G0143-G0145).

As mentioned earlier in this article" the AMA says 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 simply means that when a pathologist or facility performs both services report both codes."