Pathology/Lab Coding Alert

Question: How should we bill for multiple conventional Pap smears or thin-prep Pap smears obtained from the same patient on the same day but from different locations of the cervix? Some patients have up to four conventional smears obtained on the same day. Some of these patients have had DES exposure.

Wisconsin Subscriber Answer: You should not report multiple Pap smears from the same patient on the same day. The Pap codes do not quantify the number of slides, nor do they specify the location of the specimen beyond "cervical or vaginal."

With 21 codes available in CPT and HCPCS Level II to report a Pap smear exam, you need to be familiar with intricate coding rules to report these codes correctly. You should select one of the CPT codes for a diagnostic Pap smear that the physician ordered based on signs or symptoms of disease. But if the physician ordered the Pap smear as a screening test for a patient who shows no signs or symptoms, you should report one of the HCPCS Level II codes to Medicare (or other payer that accepts the Level II codes).

You mentioned that the patient had DES (Diethylstilbestrol) exposure, which is relevant to reporting screening Pap smears for Medicare patients. If the patient has no signs or symptoms but has a known exposure to DES, Medicare considers the patient to be at high risk for cervical cancer and covers screening Pap smears more frequently than for low-risk patients. You'd have to report the diagnosis code V15.89 (Other specified personal history presenting hazards to health; other) for this patient to secure payment for the annual Pap screening. If the medical record confirms DES exposure, you should also report 760.76 (Noxious influences affecting fetus via placenta or breast milk; Diethylstilbestrol [DES]).

Based on the lab and reporting method and slide rescreening, you should select the appropriate code from the HCPCS Level II codes for a screening Pap smear: P3000 (Screening Papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision), G0123 (Screening cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision), G0143-G0145 (Screening cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin layer preparation ...), or G0147-G0148 (Screening cytopathology smears, cervical or vaginal, performed by automated system ...)