Pathology/Lab Coding Alert

Question: We received a request for a Pap test six months following a prior Pap for the same patient that resulted in a diagnosis of ASC-H. Our lab performs a liquid-based Pap test, and the pathologist again interprets this abnormal smear as ASC-H. What are the correct code(s) for this case?

Colorado Subscriber

Answer: The correct diagnosis code for this case is R87.611 (Atypical squamous cells cannot exclude high grade squamous intraepithelial lesion on cytologic smear of cervix (ASC-H)). You should not additionally report a screening diagnosis code, because the lab performs the test based on a prior abnormal Pap diagnosis. If the findings were different for this follow-up test, you would report an additional diagnosis to describe those results.

The code for the technical lab test in this case is an appropriate CPT^® code that specifically describes your lab procedure, such as 88174 (Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision). Even if the payer is Medicare, you should not use a HCPCS Level II code, such as G0123 (Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision), because you should reserve those for screening Pap tests.

You stated that your pathologist interpreted the abnormal Pap test, and that means you should additionally report 88141 (Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician) for the professional interpretation service.