Revenue Cycle Insider

Question: Can you explain the difference between the human papillomavirus (HPV) tests?

Revenue Cycle Insider Subscriber

Answer: There are two key differences between the four CPT^® HPV tests. The first difference divides the tests between the patient’s high- or low-risk profile. Patients are regarded as low risk when they have noncancerous lesions, such as genital warts. When a physician wants to test for a low-risk strain of HPV, you’ll use 87623 (Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), low-risk types (eg, 6, 11, 42, 43, 44)).

The other tests all detect high-risk, or cancerous, strains of HPV, but they vary in their scope. Code 87624 (… Human Papillomavirus (HPV), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68), pooled result), for example, is used to describe a general cervical cancer screening. The test returns a positive or a negative result for high-risk HPV strains, but it does not specify which HPV strain the patient may have.

In contrast, 87625 (… Human Papillomavirus (HPV), types 16 and 18 only, includes type 45, if performed) only detects the strains specified in the code descriptor. These strains are statistically most likely to be malignant, and the test is usually performed to follow up a positive 87624 test. And 87626 (… Human Papillomavirus (HPV), separately reported high-risk types (eg, 16, 18, 31, 45, 51, 52) and high-risk pooled result(s)) essentially functions as a hybrid of 87624 and 87625, providing both a positive and negative result for the presence of high-risk HPV strains in a patient while simultaneously identifying the specific strain(s). Because 87626 essentially does the work of both 87624 and 87625, CPT^® instructs you not to report 87626 in conjunction with 87624 or 87625.

Understand Medicare Rules

Provided the test is accompanied by an appropriate, medically necessary diagnosis code such as R87.610 (Atypical squamous cells of undetermined significance on cytologic smear of cervix (ASC-US)), Medicare will accept 87624, 87625, and 87626. However, Medicare does have its own code, G0476 (Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test), for cervical cancer screenings for patients between 30 and 65.

Medicare recognizes G0476 instead of 87623 and will cover the screening every five years, though it must be accompanied by diagnosis codes Z11.51 (Encounter for screening for human papillomavirus (HPV)) and either Z01.411 (Gynecological exam with abnormal findings) or Z01.419 (Gynecological exam without abnormal findings) as appropriate.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC