Pathology/Lab Coding Alert

Medicare says pick one a Pap test is either for screening or for diagnostic purposes. Knowing the difference leads to two completely separate groups of codes, and National Correct Coding Initiative (NCCI) version 9.1 edits confirm that you should never report together codes from the two groups.

Physicians order screening Pap tests in the absence of signs or symptoms of disease. "If the Pap smear is for screening in an asymptomatic patient, you should report one of the HCPCS Level II codes (P3000, G0123 or G0143-G0148)," says Stacey Hall, RHIT, CPC, CCS-P, director of corporate coding for Medical Management Professionals Inc., a national billing and management firm in Chattanooga, Tenn. If the physician orders the Pap test to aid in the diagnosis of a patient with signs or symptoms of disease, use the CPT codes (88142-88154, 88164- 88167 and 88174-88175). "The code selection does not change whether the test results are positive or negative," Hall says. For either screening or diagnostic Pap tests, choose the code that accurately describes the laboratory technique, reporting system, and screening/rescreening method employed.

Use HCPCS Level II codes for Screening Pap Tests

Previous versions of NCCI bundled certain diagnostic Pap tests with certain screening Pap codes. NCCI 9.1 completes the job, adding edit pairs so that you cannot report any diagnostic Pap test (CPT codes) with any HCPCS Level II Pap screening code. "Because each of these edit pairs has a modifier indicator of '0,' under no circumstances can you override these edits and report a screening and diagnostic Pap for the same patient on the same day," says Melanie Witt, RN, CPC, MA, an independent coding educator based in Fredericksburg, Va..

The bundled HCPCS code definitions follow:

Note that the edits do not involve the HCPCS physician interpretation codes G0124 (Screening cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, ... requiring interpretation by physician), G0141 (Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician), and P3001 (Screening Papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician). "Even without NCCI edit pairs, you should continue to report these codes only with the related technical codes, such as reporting G0124 only for the interpretation of an abnormal thin-layer preparation screening Pap test such as G0123 or G0143-G0145," Witt says.

Use CPT Codes for Diagnostic Pap Tests

The following procedures were not previously bundled with any screening Pap codes, so NCCI 9.1 adds edit pairs for all the HCPCS Pap codes listed above with each of these codes:

NCCI 9.1 completes the prohibition for reporting screening and diagnostic Pap codes together by pairing 88142 (Cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision) with P3000 and G0123.