Pathology/Lab Coding Alert

Question: We're having problems with denials when we bill Medicare for a thin-prep screening Pap (G0145) along with the physician review (P3001) if the automated screening/tech rescreening identifies an abnormality. We're billing the codes with diagnosis V76.2. We've tried using modifier 59 to no avail -- how should we bill these cases?

Indiana Subscriber

Answer: You are correct to bill a screening thin-prep Pap with automated screening and manual rescreening for a Medicare patient using 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).

The problem appears to be your code choice for physician review when you detect an abnormality -- P3001 (Screening Papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician). You should report P3001 only if your lab performs the initial Pap screening using a method described by P3000 (... by technician under physician supervision).

For an abnormal thin-prep screening Pap that you report with G0145, you should report the physician interpretation as G0124 (Screening cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician).

HCPCS provides three physician interpretation codes for screening Paps. In addition to codes P3001 and G0124, you might use G0141 (... with manual rescreening, requiring interpretation by physician) in some cases.

Do this: Based on the original screening Pap method and code, you should select the proper physician interpretation code as follows:

• P3001 -- use with screening code P3000

• G0124 -- use with screening codes G0123 or G0143-G0145

• G0141 -- use with screening codes G0147 and G0148.

The diagnosis code you're reporting for a screening Pap is appropriate: V76.2 (Special screening for malignant neoplasms, cervix).