Pathology/Lab Coding Alert

ACOG makes changes
 
The type and volume of cervical cytology testing your lab does may be changing - along with coding to indicate medical necessity for those services.
 
While the effects may not be immediate, you'll want to know about new cervical cytology screening guidelines issued by the American College of Obstetricians and Gynecologists (ACOG). The guidelines indicate that Pap testing can start later and occur less often. You can access ACOG's publication on the Internet at http://www.acog.org/from_home/publications/misc/pb045.pdf.

Expect Lower Pap Volumes

If ACOG's guidelines drive policy, you may see a departure from current coverage rules as outlined in "Are You Wondering How to Code Cervical Cancer Lab Tests? Follow these 5 steps to improve your Pap reimbursement" on page 89 of this issue. The change could affect coverage for screening versus diagnostic Pap tests, as well as coverage for HPV testing.
 
ACOG's revised guidelines suggest three possible areas where labs might expect to see big decreases in Pap screening, according to Diane Davey, MD, director of cytopathology at the University of Kentucky Medical Center in Lexington.
 
First, she says, ACOG recommends that women receive their first cervical cytology screening by age 21, instead of the previously recommended age of 18. As a result of the age increase, "you may see a drop in young women being screened," Davey says.
 
Labs might also see a dip in their Pap testing volumes for women who have had hysterectomies, Davey says. ACOG suggests that "women who had a hysterectomy with removal of the cervix for benign reasons and with no history of abnormal or cancerous cell growth may discontinue routine cytology testing."

Big Change for Women 30 and Older

The third - and most significant - group likely to experience decreased Pap testing is women age 30 and older who are screened with the combined use of a cervical cytology test (see codes in the table, this issue) and a genetic test for human papillomavirus (HPV) such as 87621 (Infectious agent detection by nucleic acid [DNA or RNA]; papillomavirus, human, amplified probe technique). According to ACOG's guidelines, women who test negative on both tests should be rescreened no more frequently than every three years. Therefore, if the combined Pap/HPV screening tests "become widely used in women aged 30 or over, we could see a drop in Pap volume," Davey says. 
 
Given all of ACOG's recommendations, the decreased frequency for women over 30 using the combined Pap/HPV screening is liable to generate the most buzz among providers, says Mary Hufty, MD, chairman of Preventive Health Care Guidelines for Sutter Health Systems and the Palo Alto Medical Foundation in Palo Alto, Calif. "It's rare that ACOG would say, 'You should not screen for three years.' Usually they're trying to do a lot more screenings," she says.

HPV Testing May Increase

If the combined use of the Pap/HPV screening for women age 30 or older were to gain popularity among providers, any decrease in Pap volume would likely be accompanied by an increase in HPV volume, Davey says.
 
Some carriers and third-party payers have been covering HPV testing only as an adjunctive test for women with atypical Pap results or a history of abnormalities (see "Are You Wondering How to Code Cervical Cancer Lab Tests? Follow these 5 steps to improve your Pap reimbursement" on page 89). As a result, physicians generally haven't ordered HPVs as a screening test, Davey says. And even when the HPV test is reimbursed, "it may not be in an amount to cover the laboratory's cost," she adds.
 
However, if ACOG members want to increase HPV screening frequency, then it's possible that payers will increase their HPV testing coverage, Davey says. "If there's a lot of pressure from physicians to be able to offer [the HPV test] and if there's pressure to have the test run and laboratories aren't getting paid, then there will be pressure on the third-party payers to cover it and in a sufficient amount," she says. Nonetheless, she adds, "that may take a long time to happen."