Pathology/Lab Coding Alert

Question: Our lab performed a screening thin-layer preparation Pap smear ordered for a low-risk patient. The cytotechnologist read the slide, and having identified an abnormality, the pathologist interpreted the Pap smear as ASCUS. The requisition form indicates that the lab should reflex the thin-layer preparation to an HPV test if it is diagnosed as ASCUS. How should we code this case? Should we report the ordering diagnosis for both the Pap test and the HPV test as a screening, or should we report an ASCUS diagnosis for the HPV test since that is why we performed that test?

Arizona Subscriber

Answer: You should report V76.2 (Special screening for malignant neoplasms; cervix) as the ordering diagnosis for the screening Pap smear. For thin-layer preparation performed for a Medicare patient, report the service as G0123 (Screening cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin-layer preparation, screening by cytotechnologist under physician supervision). Report the physician's interpretation as G0124 (Screening cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin-layer preparation, requiring interpretation by physician).
 
For a non-Medicare patient, report the service using CPT codes 88142 (Cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin-layer preparation; manual screening under physician supervision) and +88141 (Cytopathology, cervical or vaginal [any reporting system]; requiring interpretation by physician [list separately in addition to code for technical service]).
 
Because the physician ordered the HPV test based on the ASCUS diagnosis, you should report 795.01 (Atypical squamous cell changes of undetermined significance favor benign [ASCUS favor benign]) as the ordering diagnosis. The common HPV lab test is 87621 (Infectious agent detection by nucleic acid [DNA or RNA]; papillomavirus, human, amplified probe technique).