Pathology/Lab Coding Alert

Question: We perform Pap tests that use computer-assisted screening of liquid-based specimens. I’ve been told that if we need a pathologist to “read” the result because the initial test result is unclear, we should report a second unit of the procedure code with modifier 26. Is this correct?

Mississippi Subscriber

Answer: No, you should not report the Pap test code with modifier 26 (Professional component) under any circumstances. The Pap test codes are technical-only codes paid on the Clinical Laboratory Fee Schedule. They are not listed on the Medicare Physician Fee Schedule and they are not subject to modifiers 26 or TC (Technical component).

The best code for the test you describe is 88174 (Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision).

Note: If you had indicated that a manual rescreening or review by clinical personnel such as a cytotechnologist was part of your Pap test lab procedure, you could report 88175 (… with screening by automated system and manual rescreening or review, under physician supervision). But you indicate that the review is requested of a pathologist due to an abnormal (questionable) finding.

Interpretation: What you’ve described is a Pap interpretation, which you should report as 88141 (Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician).

Medicare: If the payer is Medicare, you’ll need to use the following codes instead:

• G0144 (Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision)
• G0124 (Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician)