|
January 2003
Feature Story
New CPT and ICD-9-CM codes
for cervical cytology services:
Diane D. Davey, MD,
Susan E. Spires, MD
Two new cervical cytology reporting codes were accepted
last year by the American Medical Association Current Procedural
Terminology editorial panel and are published codes as of this year.
These codes will provide for accurate coding of liquid cervical
cytology specimens screened by an automated system. The two new
codes are as follows:
88174 Cytopathology, cervical or vaginal (any reporting system),
collected in preservative fluid, automated thin-layer preparation;
with screening by automated system, under physician supervision
88175 Cytopathology, cervical or vaginal (any reporting system),
collected in preservative fluid, automated thin-layer preparation;
with screening by automated system and manual re-screening, under
physician supervision (For manual screening, see 88142, 88143)
The Centers for Medicare and Medicaid Services held a meeting Aug.
5, 2002 to invite public comment on payments for these two codes
and several others under Medicare’s clinical laboratory fee
schedule. This was the second time such a meeting has been held,
and it reflects CMS’ desire to portray a more user-friendly
image.
Some organizations recommended a “crosswalk” of the
new codes to several existing CPT codes. The advantage of the crosswalk
is that the payment level is based on rate of payment with the comparable
codes. Another payment mechanism is the “gap-fill,”
in which regional medical directors determine payments for an interim
period. With gap-filling, some geographic regions may fare better
than other areas. The existing CPT codes suggested for crosswalk
are 88142 (automated preparation and manual screening of liquid
cervical cytology) and 88147/88148 (automated screening of conventional
smears without and with manual review, respectively). Since manual
screening costs are included in the 88142 code and the 88147/88148
codes include smear preparation costs, a percentage allocation was
suggested. The goal was to subtract the manual screening allocation
from the 88142 payment, then add on the automated screening allocation
included in the 88147/88148 series.
The CMS proposal used modified crosswalk methodology: 88142 + 8%
of 88147 for 88174, and 88142 + 44% of 88148 for the 88175, based
on comments received at the meeting and experience to date. While
the percentages may appear unusual, they account numerically for
the deletion of manual screening from 88142 and the addition of
automated screening costs. These proposals as posted on the CMS
Web site were subject to comment until Sept. 30, 2002 and subsequently
published in a program memorandum in November 2002.
ICD-9-CM codes
Several new ICD-9-CM diagnosis codes related to cervical cytology
were also recently published. Effective Oct. 1, 2002 (with a grace
period through Dec. 31), CMS has approved a new code for unspecified
abnormal cervical cytology, listed in the tabular index as “Nonspecific
finding NEC 795.09”:
795.09Other nonspecific abnormal Papanicolaou smear of cervix
Benign Cellular Changes
Unsatisfactory smear
New codes numbered 795.01 and 795.02 were also accepted for what
is now outdated Bethesda cytology terminology. Bethesda 2001 eliminated
the “atypical favor reactive” terms for both squamous
and glandular categories. The CAP has submitted comments to CMS
to make officials there aware of Bethesda 2001 terminology changes
and to suggest modifications.
The section in the 2003 manual will read:
795.0Nonspecific abnormal Papanicolaou smear of cervix
(Delete) Dyskaryotic cervical smear
(Add) Excludes:
Carcinoma-in-situ of cervix (233.1)
Cervical intraepithelial neoplasia I
(CINI) (622.1)
Cervical intraepithelial neoplasia II
(CINII) (622.1)
Cervical intraepithelial neoplasia III
(CINIII) (233.1)
Dysplasia of cervix (uteri) (622.1)
High grade squamous intraepithelial
dysplasia (HGSIL) (622.1)
Low grade squamous intraepithelial
dysplasia (LGSIL) (622.1)
(New code)795.00Nonspecific abnormal Papanicolaou smear of cervix,
unspecified
(New code)795.01Atypical squamous cell changes of undetermined significance
favor benign (ASCUS favor benign)
Atypical glandular cell changes of
undetermined significance favor benign
(AGCUS, favor benign)
(New code)795.02Atypical squamous cell changes of undetermined significance
favor dysplasia (ASCUS, favor dysplasia)
Atypical glandular cell changes of
undetermined significance favor dysplasia
(AGCUS, favor dysplasia)
(New code)795.09Other nonspecific abnormal Papanicolaou smear of cervix
Benign Cellular Changes
Unsatisfactory smear
The main advantage of the 795.09 code is that it will allow for
specific coding of the unsatisfactory cervical cytology specimen.
Previously, such specimens had to receive either a screening code
or a diagnostic code based on previous or current findings, if any.
The 795.09 code may also allow for more frequent cytology testing.
Current clinical guidelines recommend a repeat Pap test when a specimen
is unsatisfactory, and this code would presumably allow for coverage
of the followup specimen. It is unclear whether this code will allow
coverage for a pathologist interpretation charge for every unsatisfactory
cervical cytology specimen completely processed by the laboratory.
Many cytopathology professionals advocate pathologist review of
all processed unsatisfactory specimens as part of an effective quality
improvement program, even though such reviews were not billed in the past.
Dr. Davey is past chair of, and former advisor to, the CAP
Cytopathology Committee and professor of pathology and laboratory
medicine and laboratory director of the cytopathology and bone marrow
laboratories at the University of Kentucky Chandler Medical Center,
Lexington. Dr. Spires is a staff pathologist at Samaritan Hospital,
Lexington. The information they supply here is adapted from their
article in the December 2002 issue of the American Society of Cytopathology Bulletin.
|
|
|
