Pathology/Lab Coding Alert

Latest CCI enforces P3001 coding rules

Your pathologist interprets an abnormal screening Pap smear for a Medicare beneficiary, reports the service with 88141 -- and doesn't get paid. You don't have to let this happen if you remember rules for matching Pap technical and professional codes.

The latest Correct Coding Initiative (CCI), version 13.2, helps refresh your memory by bundling certain codes to enforce these rules.

The preceding article, "Negotiate ICD-9 Maze for Medical Necessity -- Here's How," helps you decide which code to use for a screening or diagnostic Pap test that corresponds to a specific type of lab method. These codes describe the technical service for a Pap test -- preparing and checking the slide for an abnormality using automated and/or cytotechnologist services.

Don't miss: You can only pick one technical Pap code for a single Pap test, says Melanie Witt, RN, CPC-OGS, MA, a coding expert based in Guadalupita, N.M.

If the Pap test technical service results in abnormal findings, a pathologist must interpret the slide to arrive at a diagnosis. You should report the pathologist's service with one of the following codes:

These codes represent the pathologist's professional service only.

Do this: List the professional code in addition to the technical code. Notice that you shouldn't change the technical code to a "diagnostic" code based on the abnormal finding. If the physician orders a screening test, it remains a screening test regardless of the results.

But with four professional Pap interpretation codes to choose from, how do you know which one to use?

Bottom line: CPT and HCPCS instructions pair the interpretation codes with specific technical Pap codes. For each technical code, there is only one professional code that you should use if the pathologist interprets the Pap. The pairings are as follows:

Although prior CCI versions had many edit pairs to ensure the aforementioned pairings for professional and technical Pap codes, the latest version closes the loop by adding edit pairs that bundle P3001 with all screening Pap codes except P3000. That means you should not report together P3001 and G0123 or G0143-G0148.