Pathology/Lab Coding Alert

Question: A physician sent two specimens from a single patient to our lab: a Pap smear, and a urine for cytology because the patient had blood in her urine. The lab performed an automated thin-prep Pap exam that required manual rescreening, and a urine concentration and cytology exam. We received a denial, and would like to know the proper way to report these services.


Tennessee Subscriber


Answer: The proper code for the Pap smear you described is CPT 88175 (Cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin layer preparation; with screening by automated system and manual rescreening, under physician supervision) for most payers, including Medicare if this is a diagnostic Pap that the physician ordered due to specific symptoms.

If this is a screening Pap smear for a Medicare patient who has no symptoms, the proper code is G0145 (Screening cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision). The proper code for the concentrated urine cytology exam is 88108 (Cytopathology, concentration technique, smears and interpretation [e.g., Saccomanno technique]). 

If you reported G0145 and 88108 for the two services, you should not have received a denial. But if you reported 88175 and 88108, there is a National Correct Coding Initiative edit pair that prohibits reporting these two codes together, and you would get a denial if your payer uses the NCCI edits.

The point of the 88175/88108 edit pair is evidently to prohibit labs from reporting both a thin-layer Pap smear and a cytology concentration for the same Pap specimen. If, as in your case, you have two distinct specimens, you should be able to report both services.

CMS lists each NCCI edit pair with a "modifier indicator" that tells you if you can use a modifier such as -59 (Distinct procedural service) to override the edit pair when medical necessity warrants reporting the bundled services together. In the case of the 88175/88108 bundle, NCCI lists a modifier indicator of "0," meaning you cannot override the edit pair. Effectively, you cannot get paid for these two services when the lab performs them for the same patient on the same day.