Pathology/Lab Coding Alert

Question: How should we code a case when we process a routine screening Pap smear but due to abnormal findings such as ASC-US, the pathologist goes on to interpret the slides and issue a report on the findings?

Virginia Subscriber

Answer: The answer to your question depends on whether you're reporting the service for a Medicare beneficiary or for a privately insured individual.

For Medicare, you should select the appropriate procedure codes from HCPCS Level II to describe the Pap screening and pathologist interpretation. You have lots of codes to choose from, depending on the lab method used. In this case, you'll have to report one code for the screening test, and a second code for the pathologist's interpretation of the abnormal smear.

For instance: If your lab processes the Pap test using thin-layer preparation methods, with manual screening, you should report G0143 (Screening cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision) for the screening Pap.

Because of abnormal findings, the pathologist interprets the slides, so you should additionally report G0124 (... requiring interpretation by physician) for the interpretation. Although HCPCS Level II provides multiple  codes for Pap interpretation by physician, G0124 is the code that you should pair with G0143, because both describe thin layer preparation methods.

Regarding the diagnosis coding for this example, you must report V76.2 (Special screening for malignant neoplasms, cervix) to indicate that this was a screening test. In addition, you should report 795.01 (Papanicolaou smear of cervix with atypical squamous cells of undetermined significance [ASC-US]) to demonstrate medical necessity for the physician interpretation service.

If you had performed the same series of tests with the same results for a non-Medicare patient, you should code the case this way:

• 88143 -- Cytopathology, cervical or vaginal (any reporting system),collected in preservative fluid, automated thin layer preparation; with manual screening and rescreening under physician supervision
• 88141 -- ... requiring interpretation by physician.

Code 88143 describes the same technical service as G0143. CPT only provides one code for physician interpretation of an abnormal smear -- 88141-- and you should use it with any CPT Pap test technical code when the pathologist interprets the slide.

Watch out: Private payers differ on the question of diagnosis coding for this case. Some, like Medicare, insist that the first ICD-9 code should be V76.2 to show that this was a routine screening. Then you should list 795.01 as the secondary diagnosis to show medical necessity for the 88141 service. Other payers ask that you list 795.01 as the primary diagnosis. Follow your payer guidelines in this regard.