Pathology/Lab Coding Alert

See how the experts code the following scenarios that you might encounter under the new Pap consensus guidelines.

Coding Scenario, atypical squamous cells of undetermined significance (ASC-US): An asymptomatic 32-year-old female with multiple sexual partners presents for an annual exam but has not had a Pap smear in three years. The lab uses thin-layer preparation with manual screening and computer-assisted rescreening by the cytotechnologist, and the smear returns ASC-US based on pathologist interpretation of the abnormal smear. The physician asks the lab to reflex the specimen for high-risk human papillomavirus (HPV) DNA screening.

Report the services provided as HCPCS G0144 (Screening cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin-layer preparation, with manual screening and computer-assisted rescreening by cytotechnologist under physician supervision) for the initial screening Pap test and G0124 (Screening cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin-layer preparation, requiring interpretation by physician) for the pathologist interpretation of the Pap resulting in the ASC-US interpretation. For the HPV test, report 87621 (Infectious agent detection by nucleic acid [DNA or RNA]; papillomavirus, human, amplified probe technique) for amplified probe technique.

Coding Scenario, atypical glandular cells (AGC): A previously asymptomatic 40-year-old patient presents with abnormal bleeding 13 months following her last normal Pap smear. The physician orders a diagnostic Pap test. The cervical cytologic sampling with manual screening and computer-assisted rescreening identifies abnormal cells. The pathologist interprets the Pap test, reporting findings of AGC. The physician orders colposcopy with endocervical sampling. No neoplasia is found, and the patient returns for repeat cytology every four to six months.

Code the initial diagnostic Pap test as 88144 (Cytopathology, cervical or vaginal [any reporting system]; collected in preservative fluid, automated thin-layer preparation; with manual screening and computer-assisted rescreening under physician supervision) and the pathologist's interpretation of AGC findings as +88141 (Cytopathology, cervical or vaginal [any reporting system]; requiring interpretation by physician [list separately in addition to code for technical service]). The pathologist also reports 88305 ( Endocervix, curettings/biopsy) for the specimen submitted following colposcopy. The repeat Pap tests are diagnostic, so report each subsequent analysis by the same method as 88144.

Coding Scenario, inflammation: A 22-year-old patient presents for her annual exam. Upon finding cervical discharge, the physician orders a wet-mount test in addition to the traditional, manual-screening Pap smear. The wet mount returns positive for Trichomonas, and the Pap smear reveals nonspecific inflammatory cells. After treating the infection, the physician orders a follow-up Pap smear in four months.

Report the original Pap smear in this symptomatic patient as 88164 (Cytopathology, slides, cervical or vaginal [the Bethesda System]; manual screening under physician supervision) and the pathologist's interpretation of the smear as 88141. The code for the wet mount, such as KOH or saline preps, to evaluate for Trichomonas is 87210 (Smear, primary source with interpretation; wet mount for infectious agents [e.g., saline, India ink, KOH preps]) or for Medicare, Q0111 (Wet mounts, including preparations of vaginal, cervical or skin specimens) or Q0112 (All potassium hydroxide [KOH] preparations). Also report the follow-up Pap using 88164.

Coding scenarios were prepared with the assistance of Kenneth Wolfgang, MT (ASCP), CPC, CPC-H, director of coding and analysis for National Health Systems Inc., a coding consultation company in Camp Hill, Pa.