Pathology/Lab Coding Alert

Question: In addition to a Pap smear, our lab performed an HPV test for high risk types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. The HPV test was positive, but the Pap smear was negative. In cases like this, the physician typically wants us to perform a follow-up HPV test for strains 16 and 18 only. Can we bill for both HPV tests?

Ohio Subscriber

Answer: Yes, you should be able to bill for both Human Papilloma Virus (HPV) tests in the scenario you describe, and most payers should cover both tests. 

Depending on the payer, you would report 87625 (Infectious agent detection by nucleic acid [DNA or RNA]; Human Papillomavirus [HPV], types 16 and 18 only, includes type 45, if performed) along with one of the following two codes:

• G0476 — Infectious agent detection by nucleic acid (DNA or RNA); human papillomavirus (HPV), high-risk types (e.g., 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
• 87624 — Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68)

Caution: Payers typically won’t cover two tests when one test includes the same analytes of another, as in this case, where types 16, 18, and 45 appear in all three codes. In fact, the national Correct Coding Initiative (CCI) bundles 87625 as a column 2 code with both G0476 and 87624, but allows you to override the edit pair in some circumstances.

What’s going on: The American Society for Colposcopy and Cervical Pathology (ASCCP) recommends that you perform HPV 16/18 genotyping on women who are positive for high risk HPV based on a test such as G0476 or 87624, but negative by routine cytology. That’s because HPV types 16 and 18 are the genotypes most closely associated with cervical cancer, with 60 percent of all cervical cancers associated with genotype 16 alone. For that reason, the ASCCP recommends that Pap negative women who are positive for HPV 16 or 18 proceed to colposcopy, while women who are negative by Pap test and negative for genotypes 16 and 18 may have repeat cytology and high risk HPV testing in 12 months.

Do this: To get paid for the test for HPV 16, 18, and 45 (87624) along with the comprehensive high risk HPV panel (87625 or G0476), you’ll need to append an appropriate modifier to 87624, such as 59 (Distinct procedural service) or 91 (Repeat clinical diagnostic laboratory test). Contact your payers for specific instructions.