Pathology/Lab Coding Alert

With 15 CPT Pap test choices, you have plenty of opportunity for missteps when choosing the right code. Make sure you don't fall into the following five traps when filing your lab's Pap claims:

Physicians order screening tests in the absence of signs or symptoms of disease. For many patients, you-ll see V76.2 (Special screening for malignant neoplasms; cervix:routine cervical Papanicolaou smear) to explain the reason for the test, explains Sean Weiss, CPC, CPC-P, CMPE, CCA-P, CCP-P, senior partner at The CMC Group, LLC in Atlanta.

On the other hand: -If a patient presents with symptoms or a personal history that indicates a need for the test, the Pap smear is a diagnostic test,- says Melanie Witt,RN, CPC, COBGC, MA, a coding expert based in Guadalupita, N.M.

Specifically, Medicare considers a Pap diagnostic if the patient has one of the following conditions:

- previous treated cervical, uterine, or vaginal cancer

- prior abnormal Pap smear

- abnormal findings of the vagina, cervix, uterus, ovaries, or adnexa

- a significant complaint concerning the female reproductive system

- signs and symptoms that the physician relates to a gynecologic disorder.

If you don't understand whether the Pap test is diagnostic or screening, you-ll havea hard time choosing the right Pap test code.

Learn the codes: Pap tests are the -cervical or vaginal- (gynecological) cytopathology codes. When you report a diagnostic Pap, you-ll select the code(s) from the table shown on page 26.

Results don't matter: -Remember that a Pap test is either screening or diagnostic based on the reason the physician ordered the test, regardless of the results,- Witt says.

Caution: -Don't let the words -screening- and -rescreening- in the definitions confuse you,- Witt says. The terms refer to the examination and re-examination of the slides, not to the reason for the test.

Conventional Pap smears involve the physician scraping cells from the cervix and fixing them immediately on a slide for later evaluation at the lab. To choose the right code, you-ll have to know the difference between conventional Paps and liquid-based technology, which we-ll discuss in item 4.

Based on whether the lab uses an automated or manual method for the initial evaluation, CPT provides two code families for conventional smears (other than Bethesda reporting, which you can read about in item 3).

Automated codes: If the lab uses an automated Pap smear system, use 88147 when the system screens the slides once, or 88148 when the system screens and rescreens the slides.

Manual codes: If the lab uses a manual screening method, choose the appropriate code from 88150-88154. Code 88150 describes manual screening only, while 88153 describes manual screening and rescreening. Code 88152 describes manual screening with computer-assisted rescreening, while 88154 describes the same process with additional cell selection and review.

Bethesda does not describe a lab method; rather, it is a way of reporting findings from Pap tests. But if you ignore the Bethesda, you-ll probably select the wrong Pap code.

If the lab uses the Bethesda system, the Pap test report will include a statement of specimen adequacy and possibly a general categorization, such as -negative for intraepithelial lesion or malignancy.- If the Pap shows abnormalities, the report will also include an interpretation using specific categories, such as atypical glandular cells (AGC), atypical squamous cells of undetermined significance (ASC-US), atypical squamous cells - high grade (ASC-H), etc. Finally, the report includes a statement of review and ancillary testing, if any.

For Pap smears reported with the Bethesda system, CPT provides four codes: 88164-88167. Use 88164 for a manual screening, and 88165 for a manual screening and rescreening. Use 88166 for manual screening and computer-assisted rescreening, and 88167 for the same service plus cell selection and review.

-Any reporting system- counts: You-re not limited to 88164-88167 if the lab report uses the Bethesda system. Other Pap test codes (88142-88143, or 88174-88175) allow -any reporting system,- and you can also use these codes with Bethesda results.

Liquid-based Pap tests involve the physician brushing or scraping cells into a liquid preservative, which the lab then processes with an automated system into a -thin layer- or -monolayer- slide. Thin-layer preparations have the advantage of spreading the cells out, making them easier to visualize than on thicker, conventional Pap smears.

If you miss keywords such as -liquid based,- -thinlayer,- or -monolayer,- you might choose the wrong CPT code.Know manual codes: Use 88142 to report a thin-prep Pap test that involves only a manual screening. If the liquid-based slide undergoes manual screening and rescreening, use 88143.

Differentiate automated codes: For thin-prep Pap tests processed using an automated screening system, you should select 88174 for screening only, and 88175 forautomated screening with manual rescreening.

The cervical and vaginal cytopathology codes discussed above -- 88142-88154, 88164-88167, and 88174-88175 -- are technical-only services. Although the codes mention -under physician supervision,- that doesn't refer to a professional interpretation.

If one of these tests results in an abnormal finding, you-ll have to report an additional interpretation code or miss out on your rightful pay.

Code interpretation separately: Once you have documentation that the pathologist diagnosed and interpreted the abnormal Pap slide, you can bill for the additional interpretation service. Regardless of which technical Pap code the lab uses, if the pathologist interprets an abnormal Pap, you should report the professional interpretation with 88141.

Note the difference: Non-gynecological cytopathology codes 88104-88112 and 88160-88162 describe both the technical and professional service and require modifiers TC (Technical component) or 26 (Professional component) to denote that a billing entity performed only one part of the service. You won't use these modifiers with cervical or vaginal cytopathology--Pap tests--because CPT provides a separate code (88141) for the professional service.

Who bills? If the laboratory performs the technical service and an independent pathologist interprets the abnormal test, they should bill separately. The lab should list the appropriate technical code, and the pathologist should list 88141.