Pathology/Lab Coding Alert

Question: Our pathologist is contracted by the hospital to provide pathology services. We bill pathology services independently of the hospital and the technical components. The hospital cytotechnologist screens Pap smears manually (88150), and the pathologist rescreens any abnormal Pap smears (88141). In the past, we were able to bill for 88141 alone. We are instructed by HCFA (now CMS) to bill 88141 in conjunction with 88150. We are confused about how to accomplish this. Since the physician is not performing the original screen (88150), how can we bill for it?

Colorado Subscriber

Answer: Many insurers have been denying the physician Pap interpretation code (88141, cytopathology, cervical or vaginal [any reporting system]; requiring interpretation by physician [list separately in addition to code for technical service]) when billed without a Pap test code. And, some Medicare carriers have denied HCPCS physician Pap interpretation codes (P3001, screening Papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician; G0141, screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician; and G0124, screening cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician]).

The confusion evidently stems from the fact that 88141 is listed in CPT as an add-on code and includes the direction, Use 88141 in conjunction with codes 88142-88154, 88164-88167. But, the direction does not mean that the two services must necessarily be done by the same provider or facility. It means that when a pathologist performs both services, both codes should be reported.

You are correct that you cannot bill for the Pap test (88150) because you did not carry out that service. You can bill only for the 88141 service. A written communication with your insurer or Medicare carrier may be necessary. Including supplemental literature would help, such as the article in the September 2000 issue of Pathology/Lab Coding Alert, Avert Improper Denials for Interpretation of Pap Smears, that deals specifically with this issue.