Part B Insider (Multispecialty) Coding Alert

Published on Mon Apr 28, 2008 PDF

Question: I am in a laboratory setting. For a patient whose thin-prep Pap test showed LGSIL, our lab performed low-risk and high-risk HPV DNA probe testing, with results positive for low risk and negative for high risk. What are the CPT and ICD-9 codes for the HPV testing?

Answer: The diagnosis code for ordering the human papillomavirus (HPV) tests is the Pap diagnosis 795.03 (Papanicolaou smear of cervix with low-grade squamous intraepithelial lesion [LGSIL]) because that is the Pap test results that you indicate.
 
Coverage issues: The American Society for Colposcopy and Cervical Pathology recommends HPV testing for Pap test results of atypical squamous cells of undetermined significance (ASC-US). For LGSIL, many payers indicate colposcopy as the next diagnostic step, not HPV testing.

You should also check coverage rules about low-risk HPV testing because many payers will cover only the high-risk test.

With those caveats, here's how you should code the HPV testing and results:

The most common CPT code for HPV DNA testing from a thin-prep Pap specimen is 87621 (Infectious agent detection by nucleic acid [DNA or RNA]; papillomavirus, human, amplified probe technique).  

If your lab uses some other method, such as a direct probe technique, however, you should select the appropriate code that describes your procedure.

Because the results were positive for low-risk HPV, you should report the diagnosis as 795.09 (Other abnormal Papanicolaou smear of cervix and cervical HPV).

In addition, you should indicate what the -other- HPV abnormality is by listing 079.4 (Viral and chlamydial infection in conditions classified elsewhere and of unspecified site; human papillomavirus).

Tip: You should not list the ICD-9 code that you are probably more familiar with for positive Pap/HPV test results, 795.05 (Cervical high-risk human papillomavirus [HPV] DNA test positive). Reserve 795.05 to report positive results of the high-risk HPV test.