Pathology/Lab Coding Alert

Question: The pathologist diagnoses an abnormal Pap smear as ASCUS and performs an ISH test for high-risk HPV. How should we code this?

South Carolina Subscriber

Answer: For the pathologist's interpretation of the abnormal smear, you should report 88141 (Cytopathology, cervical or vaginal [any reporting system], requiring interpretation by physician).

Because you state that the pathologist tests for HPV by ISH (in-situ hybridization), you should report the test as one of the following three codes depending on whether the results are qualitative or quantitative, and whether the pathologist used a computer-assisted system:

- 88365 -- In situ hybridization (e.g., FISH), each probe

- 88367 -- Morphometric analysis, in situ hybridization (quantitative or semi-quantitative) each probe; using computer assisted technology

- 88368 -- - manual.

Professional only? If the pathologist only interprets the ISH test and a separate billing entity performs the technical work, be sure to bill the appropriate code 88365-88368 with modifier 26 (Professional component) appended.

Know other HPV tests: Another common lab test for HPV testing from a thin-prep Pap specimen is 87621 (Infectious agent detection by nucleic acid [DNA or RNA]; papillomavirus, human, amplified probe technique). However, if your lab uses some other method, such as a direct probe technique, you should select the appropriate code that describes your procedure.

Report HPV diagnosis: Regardless of the test method, you need to assign an ICD-9 code that indicates when the test is positive for high-risk HPV. Use 795.05 (Cervical high-risk human papillomavirus [HPV] DNA test positive) to report a positive high-risk HPV diagnosis.