Pathology/Lab Coding Alert

Question: For a patient whose thin-prep Pap test showed LGSIL, our lab performed low-risk and high-risk HPV DNA probe testing, with results positive for low risk and negative for high risk. What are the CPT and ICD-9 codes for the HPV testing?
Louisiana Subscriber

 Answer: The diagnosis code for ordering the human papillomavirus (HPV) tests is the Pap diagnosis -quot; 795.03 (Papanicolaou smear of cervix with low-grade squamous intraepithelial lesion [LGSIL]) because that is the Pap test results that you indicate.
 Coverage issues: The American Society for Colposcopy and Cervical Pathology recommends HPV testing for Pap test results of atypical squamous cells of undetermined significance (ASC-US). For LGSIL, many payers indicate colposcopy as the next diagnostic step, not HPV testing.
 You also should check coverage rules about low-risk HPV testing because many payers will only cover the high-risk test. With those caveats, here's how you should code the HPV testing and results:
 The most common CPT code for HPV DNA testing from a thin-prep Pap specimen is 87621 (Infectious agent detection by nucleic acid [DNA or RNA]; papillomavirus, human, amplified probe technique). However, if your lab uses some other method, such as a direct probe technique, you should select the appropriate code that describes your procedure.
 Because the results were positive for low-risk HPV, you should report the diagnosis as 795.09 (Other abnormal papanicolaou smear of cervix and cervical HPV). You should also indicate what the -other- HPV abnormality is by listing 079.4 (Viral and chlamydial infection in conditions classified elsewhere and of unspecified site; human papillomavirus).
 You should not list the ICD-9 code that you are probably more familiar with for positive Pap/HPV test results -quot; 795.05 (Cervical high-risk human papillomavirus [HPV] DNA test positive). Reserve 795.05 to report positive results of the high-risk HPV test.