Pathology/Lab Coding Alert

CPT 1999 ushered in completely new and revised cytopathology codes for Pap screenings, and after almost a year, they still are a source of frequent questions. Fortunately, CPT 2000 contains only one minor change to the guidelines. Codes 88141-88155 and 88164-88167 should be used to report cervical or vaginal screenings by various methods and to report physician interpretation services, the new guidelines say. With a better understanding of the families of codes, levels of service, and add-on codes for Pap screenings, pathologists can better describe and capture reimbursement for their work.

For the most part, the amendments and additions in 2000 in the code reflect changes in current practices, says Elizabeth Sheppard, HT (ASCP), manager of Anatomic Pathology at Wake Forest University Baptist Medical Center in Winston Salem, NC. The codes now take into account that many more labs are using thin prep methods or automated screening systems, she continues. The codes also take into account the different systems for analyzing and reporting Pap smears, specifically Bethesda and any non-Bethesda reporting.

The introduction of computer-assisted imaging is at the root of much of the Pap guideline revisions, according to a communication in the May 1999 CPT Assistant . The Food and Drug Administration (FDA) approved one type of computer system for primary screening, which accounts for the addition of two new codes. Code 88147 is used for cytopathology smears, cervical or vaginal; screening by automated system under physician supervision. If the Pap requires manual re-screening, code 88148 is used.

All other Pap screening codes refer to methods that begin with manual, rather than computer-assisted, screening. There are three families of these codes, based on how the slides are prepared or how the results are reported. Within each family there are four levels of service:

manual screening under physician supervision;

manual screening plus manual re-screening under
physician supervision;

manual screening plus computer-assisted re-
screening that categorizes slides as either
included or excluded from the group of slides
at higher risk for abnormality, under physician
supervision; and

manual screening plus computer-assisted cell
selection of specific abnormal cells, under
physician supervision.

Select the Correct Code

Before selecting the appropriate level of service, pathologists need to decide what family they are using, advises Sheppard. Thin-layer preparation represents a growing number of Pap smears, and these slides are reported using the 88142-88145 family regardless of how the results are reported. The other two families represent traditional cytopathology smears that are analyzed and reported differently. [...]