Pathology/Lab Coding Alert

Question: Our lab has a client physician who orders a human papillomavirus test with every Pap smear. Is HPV part of a screening Pap, or can we separately report the HPV test with the Pap test? What ICD-9 code should we use?

Maryland Subscriber

Answer: A human papillomavirus (HPV) test is not part of the screening Pap smear. Although both tests can screen for cervical cancer, the HPV test checks only genetic evidence for the presence of HPV, while the Pap test looks for abnormal changes to cervical cells. Current clinical recommendations don't include routinely performing an HPV test together with the Pap smear. In addition, the United States Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against the routine use of HPV testing as a primary screening test for cervical cancer. The agency found poor evidence to determine the benefits and potential harms of HPV screening as an adjunct or alternative to regular Pap smear screening.

Use HPV after abnormal Pap: CMS and other payers will cover an HPV test after a screening Pap smear with abnormal results, especially if the Pap test showed abnormal cervical cells. In this scenario, use V73.81 (Special screening examination for viral and chlamydial diseases; other specified viral and chlamydial diseases; human papillomavirus [HPV]). Medicare covers a screening Pap smear once every two years (24 months) for female beneficiaries at low risk. Women who are at high risk -- those of childbearing age with an examination indicating the presence of cervical or vaginal cancer or other abnormalities during any of the preceding three years -- are eligible for a screening Pap smear annually (every 12 months). (Refer to "The Guide to Medicare Preventive Services," online at www.cms.hhs.gov/MLNProducts/downloads/mps_guide_web-061305.pdf.)