Pathology/Lab Coding Alert

Question:  Should we bill HPV genotyping by amplified probe technique as 87621 x 2 or 87798 x 2?

Tennessee Subscriber

Answer: You should use 87621 (Infectious agent detection by nucleic acid [DNA or RNA]; papillomavirus, human, amplified probe technique) for human papilloma virus (HPV) genotyping by amplified probe technique.

You should not list 87798 (Infectious agent detection by nucleic acid [DNA or RNA], not otherwise specified; amplified probe technique, each organism) in this case. You should never use a “not otherwise specified” code when CPT^® provides an organism-specific code.

Analyzing genotypes for HPV is common. Labs often carry out HPV screen by amplified probe technique, and you should report the screening as 87621. When the results are positive and the lab subsequently uses the same technique for HPV typing for genotypes 16 and 18, for instance, report an additional unit of 87621.

Typical high-risk HPV screening tests check for certain genotypes such as 16, 18, 31, 33, 35, 45, 51, 52, etc., which are associated with cervical lesions and cancer. A large number of cervical cancer cases may involve HPV type 16 (50-55 percent) or HPV type 18 (15-20 percent). Knowing the patient’s HPV 16 and 18 status may aid in patient prognosis, as well as evaluating the use of the HPV vaccine, which is derived from HPV types 16 and 18.

Consider modifier: Some payers may want you to report the second 87621 with modifier 91 (Repeat clinical diagnostic laboratory test) rather than using units (87621 x 2).