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. Codes 88164-88167 should be used for smears examined using the Bethesda system of reporting that include a statement of specimen adequacy, a general categorization and a descriptive diagnosis. Codes 88150-88154 should be used for Pap smears reported by any other non-Bethesda method. After determining the preparation and reporting method, the code should be assigned based on the level of service within the appropriate family.

Use All Appropriate Add-on Codes

In addition to the screening codes, there are add-on codes that may need to be reported if additional services are provided. Add-on codes do not stand alone: They are reported in addition to the appropriate screening code. For example, if a Pap smear requires interpretation by a physician after the technologist has screened the slide, 88141 should be reported in addition to the appropriate technical code. Be aware that this code should not be used for negative Pap smears, even if the pathologist reviews the slide for quality control purposes, warns Sheppard. This code only should report physician interpretation of a Pap smear that has been identified as abnormal by the initial screening. Writing a report is key to justifying this codethe pathologist cant just look at the slide, she continues.

Definitive hormonal evaluation of a Pap smear, such as a maturation index, calls for reporting add-on code 88155. The add-on code always will be reported in conjunction with the appropriate technical service code. In addition, 88155 can be reported with 88141 if both services are rendered. Some people mistakenly think 88155 and 88141 cannot be claimed together, but that is not correct because they represent two distinct services, concludes Sheppard.

CPT 2000 clarifies what has been a source of confusion in the Pap guidelines. The 1999 automated screening codes (88147-88148) inadvertently were omitted from the parenthetical notes for the add-on codes, according to the May 1999 CPT Assistant. This has led coders to believe that physician interpretation(88141) and hormone evaluation (88155) could not be reported with automated Pap screenings. The omission is corrected in the CPT 2000 guidelines. The new codes return the missing explanation, under physician supervision, to code 88148. With no other changes and a better understanding of the code families, levels of service and add-on codes, the Pap guidelines should be easier to use this year.