Ob-Gyn Coding Alert

Reader Question:

Diagnostic Pap

Question: A Medicare patient has a specific gynecological complaint (e.g., 616.10; vaginitis). I perform a pap smear, not a screening pap, but a diagnostic pap and send it off. I code CPT 88164, Bethesda pap, and it gets denied. Why?

Harry L. Stuber, MD, PC
Cookeville, Tenn.

Answer: When the physician uses a CPT code from the 80000 series, it implies that the lab work was completed in the physicians office lab. The question indicates that the pap specimen was sent to a reference lab. Therefore, it was incorrect for you to use 88164 (cytopathology, slides, cervical or vaginal [the Bethesda System]; manual screening under physician supervision). The HCPCS code Q0091 (screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) is preferred for collecting pap specimens on Medicare patients.

Distinguishing between a screening pap or a diagnostic pap is less clear. There is no CPT or HCPCS code defined for a diagnostic pap. This distinction between screening and diagnostic is made more commonly for mammography. Using the diagnosis code for vaginitis will demonstrate the diagnostic intent for this test.

Note: For more information on the Bethesda System of reporting for pap tests see Convincing Payers to Accept The Bethesda System on page 13 of the February 2000 Ob-Gyn Coding Alert.