Pathology/Lab Coding Alert

If the new Pap guidelines cause the anticipated explosion of human papillomavirus (HPV) testing, you can expect to see the fallout in both procedure and diagnosis coding.

In addition to the past choices of colposcopy or repeat Pap smear, the Consensus Guidelines for Cervical Cytological Abnormalities published earlier this year add a third choice of HPV testing for the 2 million cervical smears annually classified as atypical squamous cells of undetermined significance (ASC-US).

You can access algorithms for the guidelines at the American Society for Colposcopy and Cervical Pathology (ASCCP) Web site at http://www.asccp.org/pdfs/consensus/algorithms.pdf.

"Identifying ASC-US patients infected with high-risk HPV strains allows improved triage, identifying the subset of ASC-US patients who clearly should proceed to colposcopy," says Edward Wilkinson, MD, immediate past-president of ASCCP and chairman of the consensus guidelines steering committee.

It may also hasten the switch from traditional Pap smear technology to liquid cytology, known as "thin-layer preparation" methodology, because the patient with ASC-US interpretation does not have to return for specimen collection to test for the presence of high-risk HPV, the primary causative agent of cervical cancer. The initial cervical specimen can be "reflexed" for HPV testing. "Using the liquid cytology Pap test and reflexing to the HPV test for ASC-US patients may help avoid unnecessary colposcopy, as well as provide a cost and convenience benefit," Wilkinson says. If a traditional Pap test results in ASC-US classification, the patient must return for additional cervical sampling to proceed with the HPV testing, or return for a repeat Pap smear or colposcopy. Choose Liquid Cytology Pap Test Code Already the most common method for Pap tests, the new guidelines may encourage even greater use of thin-layer preparation methodology. "You have to decide which code to use for this service based on whether the Pap test is ordered for diagnostic or screening purposes," says Melanie Witt, RN, CPC, MA, an independent coding consultant based in Fredericksburg, Va., and former program manager for the American College of Obstetricians and Gynecologists' department of coding and nomenclature.

You should report screening Pap tests, ordered in the absence of signs or symptoms of disease, with HCPCS Level II codes (see "Choose Between Two Sets of Liquid Cytology Codes" at left). Physicians generally order these tests with diagnoses such as V76.2 (Routine cervical Papanicolaou smear) or V15.89 (Other specified personal history presenting hazards to health, other). If the doctor orders a Pap test due to presenting symptoms such as abnormal vaginal bleeding (626.6, Metrorrhagia), the test is diagnostic, and you should report it with one of the appropriate CPT codes. Select the proper [...]