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Pap smear with pathologist reading

  1. #1
    Default Pap smear with pathologist reading
    Medical Coding Books
    I am hoping for some feed back on a problem we are having. We are a family practice office, that uses an outside lab for our pathology needs. When a patient comes in for her routine pap smear, our reference lab charges us for 88175. Which is correct.
    88175 is for a thin prep with reading through an automated system and manual rescreening or review, under physician supervision.

    The problem is that they have now recently started also charging us 88141 with a modifier 26 whenever the machine kicks a pap out for whatever reason, including insufficient cells.
    88141 is for cytopathology, cervical or vaginal (any reporting system) requiring interpretation by a physician.

    Our problem is that we don't feel we can legally bill the patient for a professional component that we did not perform. There is also the fact that it seems like double billing for the same service, because 88175 includes the review.

    We have tried to resolve this with them, but they have not been very responsive. Any thoughts on if this is correct billing, or resources that back up our stance. Thanks!

  2. #2
    Default
    That seems odd to charge 88141-26 because 88141 has no separate technical and professional components. For 88141 to be charged, a physician interpretation of the pap smear must have been done. That is, a physician needs to have looked at it, given an interpretation, and signed the report. If the cytotech or automated system considers the pap unsatisfactory but no physician looked at it, then 88141 cannot be charged.

    From what I read in Padgets, labs are mixed on whether or not they charge 88141 for unsatisfactory paps that were interpreted by a physician, and there appears to be no official guidance from CMS or the AMA on this issue.

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