Pathology/Lab Coding Alert

Medicare says pick one a Pap test is either for screening or for diagnostic purposes. Knowing the difference leads to two completely separate groups of codes, and National Correct Coding Initiative (NCCI) version 9.1 edits confirm that you should never report together codes from the two groups. Physicians order screening Pap tests in the absence of signs or symptoms of disease. "If the Pap smear is for screening in an asymptomatic patient, you should report one of the HCPCS Level II codes (P3000, G0123 or G0143-G0148)," says Stacey Hall, RHIT, CPC, CCS-P, director of corporate coding for Medical Management Professionals Inc., a national billing and management firm in Chattanooga, Tenn. If the physician orders the Pap test to aid in the diagnosis of a patient with signs or symptoms of disease, use the CPT codes (88142-88154, 88164- 88167 and 88174-88175). "The code selection does not change whether the test results are positive or negative," Hall says. For either screening or diagnostic Pap tests, choose the code that accurately describes the laboratory technique, reporting system, and screening/rescreening method employed. Use HCPCS Level II codes for Screening Pap Tests Previous versions of NCCI bundled certain diagnostic Pap tests with certain screening Pap codes. NCCI 9.1 completes the job, adding edit pairs so that you cannot report any diagnostic Pap test (CPT codes) with any HCPCS Level II Pap screening code. "Because each of these edit pairs has a modifier indicator of '0,' under no circumstances can you override these edits and report a screening and diagnostic Pap for the same patient on the same day," says Melanie Witt, RN, CPC, MA, an independent coding educator based in Fredericksburg, Va.. The bundled HCPCS code definitions follow:   G0123 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision     G0143 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision     G0144 Screening cytopathology, cervical or vaginal (any reporting system), collected in preser- vative fluid, automated thin layer preparation, with screening by automated system, under physician supervision     G0145 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision     G0147 Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision     G0148 Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening     P3000 Screening Papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision.   Note that the edits do [...]