Pathology/Lab Coding Alert

Removing add-on status allows $22

CPT 2006 subtracted the "+" from Pap interpretation code 88141--and that should make all the difference for pathologists who bill only the professional service.

Payers can no longer refuse to pay 88141 when the physician does not also bill the technical Pap code.

Definition Implied 1 Bill for Pap Test, Interpretation

Some insurers have denied the physician Pap interpretation code based on the old definition--+88141 (Cytopathology, cervical or vaginal [any reporting system], requiring interpretation by physician [list separately in addition to code for technical service])--when billed without a Pap test code like CPT 88142 (Cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin- layer preparation; manual screening under physician supervision) or 88164 (Cytopathology, slides, cervical or vaginal [the Bethesda system]; manual screening under physician supervision).

Prior to 2006, 88141 was an add-on code and the definition instructed, "list separately in addition to code for technical service." A text note following the code added to the confusion by stating, "Use 88141 in conjunction with 88142-88154, 88164-88167, 88174-88175."

"Some payers interpreted 'in conjunction with' to mean that both codes must be on the same bill," says  Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc., a pathology business practices publishing company in Simpsonville, Ky.

Pap and Interpretation Stand Alone

New code definitions and instructions clarify Pap coding. The technical Pap test code and the pathologist's interpretation, if needed, do not have to be on the same bill.

Problem solved: CPT 2006 changes 88141 by removing the "+" and the part of the code definition that states, "(list separately in addition to code for technical service)." The text note following 88141 still says, "Use 88141 in conjunction with 88142-88154, 88164-88167, 88174-88175."

But using 88141 "in conjunction with" a Pap test code does not mean that the physician or facility must necessarily bill both services. The new terminology accommodates the situation in which an independent lab provides and bills the technical service separate from the pathologist, who bills only the interpretation.

According to the AMA's CPT Changes 2006, An Insider's View, eliminating add-on status for 88141 "will allow reporting for professional interpretation by a physician or pathologist who is not associated with the laboratory providing the technical component."

Watch for: The problem of payers denying 88141 when billed without a Pap-test code first arose approximately six years ago. "Many payers corrected their error years ago, based on education by the pathology community," Padget says. "Because of the belated descriptor change, pathologists and independent labs should monitor their payments for the next few months to make sure an insurer here or there doesn't misinterpret what the AMA has done."