Pathology/Lab Coding Alert

Question: Our lab performed an HPV test for a 40-year-old patient who has not had a gynecological screening in five years. The results were high-risk HPV positive. How should we code this?

Florida Subscriber

Answer: Assuming the HPV test is for a screening, because you don’t mention signs or symptoms or past diagnoses, you should report the ordering diagnosis as Z11.5 (Encounter for screening for human papillomavirus (HPV)). For the high-risk HPV positive finding, you may also report R87.810 (Cervical high risk human papillomavirus (HPV) DNA test positive).

You don’t mention if the physician ordered a PAP test at the same time, but if so, and the payer is Medicare, you’ll need to code the test procedure using G0476 (Infectious agent detection by nucleic acid (DNA or RNA); human papillomavirus (HPV), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test).

Unless you’re required to report the HCPCS Level II code, you’ll choose the code for the high-risk HPV test in this case based on your lab’s specific test method, such as the following codes:

• 87624 (Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68))
• 87625 (… Human Papillomavirus (HPV), types 16 and 18 only, includes type 45, if performed)
• 0500T (Infectious agent detection by nucleic acid (DNA or RNA), Human Papillomavirus (HPV) for five or more separately reported high-risk HPV types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) (ie, genotyping))

Reader Questions and You Be the Coder were prepared with the assistance of R.M. Stainton Jr., MD, president of Doctors’ Anatomic Pathology Services in Jonesboro, Ark.