Pathology/Lab Coding Alert
Reality Check New Pap Codes Reflect Laboratory Practice
"Thin prep" Pap tests are in, but manual screenings are out. So what's a coder to do? CPT and HCPCS Codes 2003 solve the dilemma with new or altered codes that mirror common lab methods. Know CPT and HCPCS Thin Prep Code Similarities CPT and HCPCS Level II codes for thin prep Pap tests have similar lab-technique definitions and can be paired accordingly to assist in code selection. Use one of these first two codes to describe manual thin prep Pap screening without rescreening: Two codes describe thin prep Pap with manual screening and rescreening: For the next pair, use either the new 2003 CPT code or modified HCPCS code for the now-common automated-screening thin prep method. Deleted code 88144 and the 2002 code G0144 described thin prep Pap tests with initial manual screening followed by computer-assisted rescreening, a method that labs rarely use now. The following codes replace deleted code 88145 and the 2002 code definition for G0145, which reported thin-layer manual screening with rescreening using cell selection, another method that labs no longer commonly use. The 2003 codes better represent the technology that lab personnel have. Use either the following new 2003 CPT code or modified HCPCS code for thin-layer Pap tests with automated screening and manual rescreening, a procedure now common in many labs, Sheppard says. Reason for Test Dictates Code Selection Regardless of the changes, understanding the difference between screening and diagnostic Pap smears is the key to using these codes correctly. Screening Pap tests are those ordered in the absence of signs or symptoms of a disease. Separately Report Physician Evaluation If a screening Pap test identifies abnormal cells, remember that you should not change the code to a diagnostic code. Rather, for interpretation of an abnormal Pap, whether screening or diagnostic in origin, report an additional code for the physician evaluation of the specimen. Use New CPT Level III Code for Pap Plus Speculoscopy CPT 2003 added two emerging-technology Level III codes for a Pap test and speculoscopy. Code 0031T (Speculoscopy) describes the chemiluminescent, magnified cervical exam, and 0032T ( with directed sampling) reports the light exam plus Pap smear collection. You should use these codes to report testing with PapSure, for example.
A growing number of labs perform thin prep Pap tests, which use liquid cytology thin-layer preparation techniques rather than conventional Pap smear methodology. "Although codes for thin prep methods have existed for years, automation has altered common screening and rescreening practices, leaving the codes out of sync with what's done in the lab," says Elizabeth Sheppard, HT (ASCP), manager of anatomic pathology at Wake Forest University Baptist Medical Center in Winston Salem, N.C.
All that changes this year as CPT 2003 deletes two codes and adds two others, while HCPCS 2003 changes two code definitions to mirror current lab practice.
"If the patient presents with symptoms or a personal history that indicates a diagnostic purpose for the test, the Pap is not considered screening," says Melanie Witt, RN, CPC, MA, an independent coding educator based in Fredericksburg, Va. "The Pap test is either screening or diagnostic based on the reason the physician ordered the test, regardless of the test results."
Report screening Pap tests using the appropriate HCPCS code, and bill diagnostic Pap tests using the appropriate CPT code. For thin prep Pap tests, you would select one of the above G codes for screening or one of the above 80000-level codes for a diagnostic test based on whether the slide review is manual or automatic, and whether the slide requires a second examination. Don't be confused by the diagnostic code definitions. The terms "screening and rescreening" in the definitions do not mean that it is a screening test. Rather, the terms refer to the examination and re-examination of the slides.
A host of other HCPCS and CPT codes describe other Pap smear and reporting system methods aside from the thin prep Pap codes. If your lab uses traditional Pap smear testing, report the service with the appropriate, non-thin prep codes such as 88147-88154, 88164-88167, G0141-G0143, G0147-G0148 and P3000.
For diagnostic Pap tests requiring physician interpretation, report +88141 (Cytopathology, cervical or vaginal [any reporting system]; requiring interpretation by physician [list separately in addition to code for technical service]) in addition to the original Pap test code. For physician examination of abnormal findings from a screening thin layer Pap test, report G0124 (Screening cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin-layer preparation, requiring interpretation by physician) as well as the original G code. Note that HCPCS has different physician interpretation codes for screening Pap smears not performed by thin-layer prep methodology.
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