Pathology/Lab Coding Alert

"Thin prep" Pap tests are in, but manual screenings are out. So what's a coder to do? CPT and HCPCS Codes 2003 solve the dilemma with new or altered codes that mirror common lab methods.

A growing number of labs perform thin prep Pap tests, which use liquid cytology thin-layer preparation techniques rather than conventional Pap smear methodology. "Although codes for thin prep methods have existed for years, automation has altered common screening and rescreening practices, leaving the codes out of sync with what's done in the lab," says Elizabeth Sheppard, HT (ASCP), manager of anatomic pathology at Wake Forest University Baptist Medical Center in Winston Salem, N.C.

All that changes this year as CPT 2003 deletes two codes and adds two others, while HCPCS 2003 changes two code definitions to mirror current lab practice. Know CPT and HCPCS Thin Prep Code Similarities CPT and HCPCS Level II codes for thin prep Pap tests have similar lab-technique definitions and can be paired accordingly to assist in code selection. Use one of these first two codes to describe manual thin prep Pap screening without rescreening:

88142 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin-layer preparation; manual screening under physician supervision
G0123 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin-layer preparation, screening by cytotechnologist under physician supervision. Two codes describe thin prep Pap with manual screening and rescreening:
88143 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin-layer preparation; with manual screening and rescreening 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. For the next pair, use either the new 2003 CPT code or modified HCPCS code for the now-common automated-screening thin prep method. Deleted code 88144 and the 2002 code G0144 described thin prep Pap tests with initial manual screening followed by computer-assisted rescreening, a method that labs rarely use now.
88174 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin-layer preparation; screening by automated system, under physician supervision
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. The following codes replace deleted code 88145 and the 2002 code definition for G0145, which reported thin-layer manual screening with rescreening using cell selection, another method that labs no longer commonly use. The 2003 codes better represent the technology that lab personnel have. Use either the following new 2003 CPT code or modified HCPCS code for thin-layer Pap tests with automated screening and manual rescreening, a procedure now common [...]