Pathology/Lab Coding Alert

Question: How should we code endocervical brushings collected in cytology fixative and made into thin-layer preparation slides? Should we use gynecological or non-gyn cytology codes since this is not a -cervical- brushing?


Ohio Subscriber

Answer: You should consider this specimen a gynecological cytology case; therefore, you would report the service using the appropriate Pap test code.

The example involves thin-layer preparation, so you should report either 88142-88143 (Cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin-layer preparation; ...) or 88174-88175 (Cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin-layer preparation; ...).

Although CPT uses the terms -cervical or vaginal,- not -endocervical,- to describe Pap tests, the cells you describe represent a gynecological cytology specimen. To understand why, you need to know a little bit about anatomy and how physicians take the Pap test specimen.

The surface of the exocervix is covered with squamous cells, and the surface of the cervical canal, or endocervix, is covered with columnar cells. The -transformation zone- is the junction of these two areas where columnar cells change into squamous cells. Because this is an area of rapid cellular change, the transformation zone is often where doctors can find precursors to cancer.

That means physicians must sample the exocervix and endocervix to ensure that the specimen includes cells from the transformation zone for accurate Pap testing.