Pathology/Lab Coding Alert

Question: Our lab processed a screening Pap test and reported ASCUS findings, then reflexed to an HPV test. How should we code this?

Georgia Subscriber

Answer: You should bill the screening Pap test using a diagnosis code such as Z12.4 (Encounter for screening for malignant neoplasm of cervix). You should bill the procedure using the appropriate test code based on lab method and payer, such as one of the following:

• 88142 (Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening 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). Medicare requires HCPCS Level II codes for screening Pap tests.

For the ASCUS findings, you should code R87.610 (Atypical squamous cells of undetermined significance on cytologic smear of cervix (ASC-US)). That becomes the "ordering diagnosis" to show medical necessity for the reflex test for human papilloma virus (HPV).

Bill the appropriate code for the HPV test, typically for high-risk types, such as 87624 (Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68)).

Finally, if the HPV test is negative, you're done. But if lab test results in positive HPV findings, you should also report R87.810 (Cervical high risk human papillomavirus (HPV) DNA test positive).