Pathology/Lab Coding Alert

Distinguish reason for repeat Pap.

When your lab performs Pap tests, do you know the ins and outs of reporting the proper procedure and diagnosis codes to make sure you get paid for your services?

Read the following questions and try to answer them, then see how well you know your stuff by turning to the answers on page 12.

Scenario 1: We received a Pap test order 13 months after the previous test due to “high risk sexual behavior.” However, the ordering physician listed the diagnosis as Z12.4 (Encounter for screening for malignant neoplasm of cervix), which resulted in a denial. Is there anything we can do to get this test covered?

Scenario 2: A physician ordered a repeat Pap due to abnormal findings on a prior screening Pap six months earlier. The follow-up Pap requires a pathologist’s interpretation. How should we code the case?

Scenario 3: The lab returned Pap smear results as “unsatisfactory smear,” so the physician submitted a second Pap test in three months — sooner than allowable by coverage rules for either high- or normal-risk patients. Is there any way to get reimbursement for this test?