Pathology/Lab Coding Alert

A Pap smear that appears abnormal requires interpretation by a physician, but some pathologists find it difficult to receive fair payment for it, especially if the payer is Medicare. Carriers often deny these claims because coders misapply one of four physician Pap interpretation codes: 88141 (cytopathology, cervical or vaginal [any reporting system]; requiring interpretation by physician [list separately in addition to code for technical service]), P3001 (screening papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician), HCPCS G0124 (screening cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician) or G0141 (screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician). Payment for physician interpretation of Pap smears depends on properly linking the diagnosis code, the Pap smear code and the physician interpretation code.

By understanding when and how to use these codes, pathologists should be able to ensure fair payment for their work, says Stacey Hall, RHIT, CPC, CCS-P, director of corporate coding for Medical Management Professionals Inc., a billing and practice management firm headquartered in Chattanooga, Tenn.

Pap Coding Primer

A Pap smear involves preparing cervical or vaginal cytopathology smears and reviewing them for abnormal cell changes. There are multiple technical methods for providing this service, which may be carried out by a cytotechnologist or an automated system, under physician supervision. Fourteen CPT codes and seven HCPCS codes describe it. The differences in these codes are based on lab method, reporting system and whether the Pap smear was ordered for screening or diagnostic purposes.

Regardless of which Pap smear code is reported, if the review of the slides identifies abnormal cellular changes, a physician must provide an additional service of interpreting the smear. The physician will interpret the slides and determine the diagnosis, Hall says. Regardless of whether the pathologist confirms abnormal cellular changes, he or she must write a report explaining the findings to justify the physician interpretation service.

Assigning the Correct Pap Smear Code

The first step in assigning the correct interpretation code is choosing the correct Pap smear code. If the wrong Pap smear code is assigned, the wrong interpretation code will be assigned as well, and both services will be denied, Hall says. The Pap smear codes are first based on the reason the test was ordered: as a screening test in the absence of signs and symptoms of disease, or as a diagnostic test because of signs of disease.

If the Pap smear is for screening in an asymptomatic patient, one of the HCPCS codes (P3000, G0123 or G0143-G0148) should be used, Hall says. If the Pap smear is ordered to [...]