College of American Pathologists
CAP Committees & Leadership CAP Calendar of Events Estore CAP Media Center CAP Foundation
 
About CAP    Career Center    Contact Us      
Search: Search
  [Advanced Search]  
 
CAP Home CAP Advocacy CAP Reference Resources and Publications CAP Education Programs CAP Accreditation and Laboratory Improvement CAP Members
CAP Home > CAP Reference Resources and Publications > CAP TODAY > CAP TODAY 2004 Archive > New CPT and ICD-9-CM codes
Printable Version

  PAP/NGC Program Review

 

 

 

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.

   
 

 

 

   
 
 © 2014 College of American Pathologists. All rights reserved. | Terms and Conditions | CAP ConnectFollow Us on FacebookFollow Us on LinkedInFollow Us on TwitterFollow Us on YouTubeFollow Us on FlickrSubscribe to a CAP RSS Feed