Pathology/Lab Coding Alert

Updated 88175 clarifies ThinPrep coding

Now you can get paid $7 for rescreening your automated liquid-based Pap test even if the cytotechnologist manually reviews only selected portions of the slide.

CPT Codes 2006 clarifies the difference between “review” and “rescreening” and allows 88175 to pay the same for both services.

Understand Manual Review and Rescreening

Based on the old code definition, some labs were unsure if they could report 88175 (Cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin-layer preparation; with screening by automated system and manual rescreening, under physician supervision) when they used the Cytyc ThinPrep Imaging System for Pap test evaluation.

Because the cytotechnologist does not always rescreen the entire slide, some argued that 88175 did not describe this automated imaging system that selects 22 fields for manual review.

Update: For 2006, adding “or review” to the 88175 code definition clarifies that it is the appropriate code, even for tests that do not rescreen the entire slide. To further clarify the difference between rescreening and review, CPT 2006 adds the following direction at the beginning of the cytopathology section:

“Manual rescreening requires a complete visual reassessment of the entire slide initially screened by either an automated or a manual process. Manual review represents an assessment of selected cells or regions of a slide identified by initial automated review.”

ThinPrep Example 

A physician sends a cervical brush and scraping in a vial with preservative fluid to the lab for evaluation. The lab uses an automated system to prepare a liquid-based ThinPrep slide. The ThinPrep Imaging System then scans the slide and identifies the 22 most significant fields for manual review.

The cytotechnologist then examines the 22 fields and identifies no atypical cells. “You should report this service as 88175,” says Melanie Witt, RN, CPC-OGS, MA, an independent coding consultant based in Guadalupita, N.M.

Distinguish Liquid-Based Paps
 
CPT 2006 also adds language in the cytopathology section to distinguish “conventional” and “liquid-based” Pap tests. Conventional Pap smears involve the physician scraping cells from the cervix and fixing them immediately on a slide for later evaluation at the lab.

Liquid-based Pap tests, on the other hand, involve the physician brushing or scraping cells into a liquid preservative, which the lab then processes with an automated system into a “thin layer” or “monolayer” slide. “Thin-layer preparations have the advantage of spreading the cells out, making them easier to visualize than on thicker, conventional Pap smears,” says Debbie Siena, HT(ASCP), QIHC, president of Tissue Techniques Pathology Laboratory in Dallas.

Here’s the coding difference: The new cytopathology instructions specify that 88150-88154 and 88164-88167 describe conventional Pap smears, while you should use 88142-88143 and 88174-88175 for thin-layer preparation Pap smears. See the table “Diagnostic Pap Test CPT Codes” for full code descriptions.

Know the Bethesda Difference

The cytopathology section introduction for CPT 2006 also contains language about Bethesda vs. non-Bethesda reporting systems. “Bethesda does not describe a lab method; rather, it is a way of reporting findings from Pap tests using any lab method,” Witt explains.

If the lab uses the Bethesda system, the report will include a statement of specimen adequacy and possibly a general categorization, such as “negative for intraepithelial lesion or malignancy.” If the Pap shows abnormalities, the report will also include an interpretation using specific categories such as AGC, ASC-US, ASC-H, etc. Finally, the report includes a statement of review and ancillary testing, if any.

Pap codes that specify the Bethesda reporting system include 88164-88167. Pap codes that state “any reporting system” may use Bethesda, but not necessarily. These include all the thin-layer preparation codes: 88142-88143 and 88174-88175. You can only use the following codes for non-Bethesda, conventional Pap tests: 88147-88154. See the table “Diagnostic Pap Test CPT Codes” for full code descriptions.