Pathology/Lab Coding Alert

Question: The physician ordered a screening Pap smear. Our lab used the Thin-Prep method and, in this case, reflexed to an HPV nucleic acid test because the Pap result was ASC-US. The HPV test was positive for the high-risk strain. What are the correct diagnosis and procedure codes for this case?


Ohio Subscriber


Answer: For a screening cervical Pap smear, when the ordering physician indicates no signs or symptoms, the correct diagnosis code is V76.2 (Special screening for malignant neoplasms; cervix).

For a Medicare patient, report the screening thin-layer Pap test as G0123 (Screening cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin-layer preparation, screening by cytotechnologist under physician supervision). And report the physician's interpretation to arrive at the abnormal ASC-US diagnosis as G0124 (Screening cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin-layer preparation, requiring interpretation by physician).

For a non-Medicare patient, use CPT codes to report the service: 88142 (Cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin-layer preparation; manual screening under physician supervision) for the screening and +88141 (Cytopathology, cervical or vaginal [any reporting system]; requiring interpretation by physician [list separately in addition to code for technical service]) for the required physician interpretation of an abnormal smear.

Beware of reflex testing: You state that the lab -reflexed to an HPV- test based on the abnormal (ASC-US) Pap test results. If the ordering physician signs a requisition form that indicates an ASC-US or higher Pap result reflexes to HPV, you can use the Pap result as the ordering diagnosis for the HPV test. The correct ICD-9 code is 795.01 (Papanicolaou smear of cervix with atypical squamous cells of undetermined significance [ASC-US]).

You don't specify the type of nucleic acid HPV test your lab performs, but the common test is 87621 (Infectious agent detection by nucleic acid [DNA or RNA]; papillomavirus, human, amplified probe technique). Use 87620 for direct probe or 87622 for HPV quantification. If the lab performs separate tests for the low-risk HPV strain and the high-risk HPV strain, you may report two units of the appropriate test code (such as 87621 x 2). Caution: Many payers won't cover the low-risk test.

In your example, you should report the results of the HPV test as 795.05 (Cervical high-risk human papillomavirus [HPV] DNA test positive).

Low risk is different: If the patient had been positive for the low-risk HPV strain, report the diagnosis as 795.09 (Other abnormal papanicolaou smear of cervix and cervical HPV). Because this code does not specify the -other- condition, you would also report 079.4 (Human papillomavirus).