Pathology/Lab Coding Alert

Question: When our lab gets requests for a Pap test ordered with V76.2 , I've been told that we should code the test as 88141. But from what I've found on the Medicare Website, the correct code is P3000. Could you please clarify correct coding for Pap tests?

California Subscriber

Answer: When a physician orders a screening Pap smear using ICD-9 code V76.2 (Screening for malignant neoplasms of the cervix, routine cervical Papanicolaou smear), you should assign the CPT® or HCPCS Level II technical code for the test based on the payer and the lab method used.

The code you reference, P3000 (Screening Papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision) would be the proper code for a Medicare beneficiary if the lab processes traditional Pap smear slides (not thin layer preparation) that a lab tech screens for abnormality (as opposed to an automated system) under physician supervision.

Technical codes: CPT® and HCPCS Level II list numerous codes that describe the technical work involved in a Pap test. The codes vary based on lab method, automated versus manual, and screening/rescreening processes. Medicare requires the HCPCS Level II codes for screening Pap tests. Many other payers accept CPT® codes for a screening Pap test. The following table shows the CPT® code and the corresponding HCPCS Level II codes that describe the Pap test.

The table shows the CPT® codes and the corresponding HCPCS Level II codes that describe the technical Pap test (corresponding HCPCS code definitions similar, but not identical to CPT® codes).

Interpretation is extra: If the initial Pap test demonstrates an abnormality, then a pathologist will evaluate the slides and assign a diagnosis based on the findings. If this occurs, you need to report an additional code for the pathologist's interpretation. Selecting the proper code will depend on the initial procedure, as follows:

• 88141 -- Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physicianUse with any of the CPT® screening codes: 88142-88154, 88164-88167, 88174-88175
• P3001 -- Screening Papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physicianUse with screening code P3000
• G0124 -- Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin-layer preparation, requiring interpretation by physician Use with screening codes G0123 or G0143-G0145
• G0141 -- Screening cytopathology, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physicianUse with screening codes G0147 and G0148.