Pathology/Lab Coding Alert

Question: We perform both "high-risk" and "low-risk" HPV tests on the same specimen using amplified probe technique. The same CPT code describes both tests. Can we report the two tests separately, or can we only do so if we perform the tests on different specimens?

Washington Subscriber

Answer: If the lab performs two separate tests to identify low-risk and high-risk HPV strains, report each test as 87621 (Infectious agent detection by nucleic acid [DNA or RNA]; papillomavirus, human, amplified probe technique).

If you perform different antigen detection tests on the same specimen to identify different infectious agents, you can individually report each test. CPT clarifies this point in the instructions for these codes: "When separate assays are performed for different species or strain(s) of organisms, each assay should be reported separately."

Some Medicare carriers have local policies regarding HPV testing, so you should check coverage rules that apply to you. Payers may cover only high-risk testing, and/or may cover only HPV testing based on certain abnormal Pap smear findings. Also check with your carrier for their rules regarding multiple units of a single test - some may require you to use modifier -59 (Distinct procedural service) if you report two units of 87621.

Although you can report together two separate tests for different infectious agents performed on the same specimen, you can't report together two separate tests for the same organism from the same specimen performed by different methods.

National Correct Coding Initiative edits have bundled many infectious agent antigen detection codes to prohibit the latter activity. See "Get the Scoop on Infectious Agent Bundling" in the September 2004 Pathology/Lab Coding Alert for a complete discussion of this issue.