Pathology/Lab Coding Alert

Question: We are having problems with 88141 for Aetna patients. They are denying them as "N303 Missing/incomplete/invalid principal procedure date." We even appealed one claim and the response was only that the original determination was correct. Have you ever seen this rejection, and what can we do to overcome the problem?

Pennsylvania Subscriber

Answer: Yes, others have reported similar rejections, although it is becoming much less frequent. You’ll need to talk with your payer representative to resolve the issue, but we can give you some ammunition:

You use 88141(Cytopathology, cervical or vaginal [any reporting system], requiring interpretation by physician) to report your pathologist’s interpretation of a Pap smear when the test shows abnormal findings.

You use a different code for the Pap smear itself, depending on the lab method used, which you can select from the following list:

88142 -- Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, manual screening under physician supervision

88143 -- with manual screening and rescreening under physician supervision

88147 -- Cytopathology smears, cervical or vaginal, screening by automated system under physician supervision

88148 -- screening by automated system with manual rescreening under physician supervision

88150 -- Cytopathology, slides, cervical or vaginal; manual screening under physician supervision

88152 -- with manual screening and computer-assisted rescreening under physician supervision

88153 -- with manual screening and rescreening under physician supervision

88154 -- with manual screening and computer-assisted rescreening using cell selection and review under physician supervision

88164 -- Cytopathology, slides, cervical or vaginal (the Bethesda System); manual screening under physician supervision

88165 -- with manual screening and rescreening under physician supervision

88166 -- with manual screening and computer-assisted rescreening under physician supervision

88167 -- with manual screening and computer-assisted rescreening using cell selection and review under physician supervision

88174 -- Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision

88175 -- with screening by automated system and manual rescreening or review, under physician supervision.

Prior to 2006, 88141 was an add-on code and the definition instructed, "list separately in addition to code for technical service." A text note following the code added to the confusion by stating, "Use 88141 in conjunction with 88142-88154, 88164-88167, 88174-88175."

Some payers interpreted ‘in conjunction with’ to mean that both codes must be on the same bill.

CPT^® 2006 changed 88141 by removing the "+" and the part of the code definition that states, "(list separately in addition to code for technical service)." However, the text note following 88141 still says, "Use 88141 in conjunction with 88142-88154, 88164-88167, 88174-88175."

But using 88141 "in conjunction with" a Pap test code does not mean that the physician or facility must necessarily bill both services. The terminology change accommodates the situation in which an independent lab provides and bills the technical service separate from the pathologist, who bills only the interpretation.

According to the AMA’s CPT^® Changes 2006, An Insider’s View, eliminating add-on status for 88141 "will allow reporting for professional interpretation by a physician or pathologist who is not associated with the laboratory providing the technical component."

Bottom line: You should talk to a payer representative and show them the documentation indicating that you should be allowed to bill 88141 without billing the Pap technical test code on the same claim.