Pathology/Lab Coding Alert

Question: When our lab performs an automated Pap smear for a Medicare patient that requires physician interpretation due to abnormal findings, we-ve had denials when we bill G0147 and G0141 together. How can we resolve this?

Wisconsin Subscriber

Answer: You probably had these denials because Correct Coding Initiative edits paired G0147 (Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision) with G0141 (Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician). CCI listed the edit pair with a modifier indicator of -0,- meaning that you could not use a modifier to override the edit pair.

You should no longer have problems reporting G0147 and G0141 together when you demonstrate medical necessity for physician interpretation of an abnormal screening Pap smear. The July 2007 CCI quarterly update deleted edit pairs that bundled G0147 with G0141, as well as G0145 (Screening 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) with G0141. If you continue to get denials, you will need to appeal the claim and point out the edit deletion.