College of American Pathologists

  Your CPT Questions


Reprinted from February 2002 CAP TODAY

Q: Should we use code 88108, Cytopathology, concentration technique, smears and interpretation (eg, Saccamanno technique), in addition to code 88173, Cytopathology, evaluation of fine needle aspirate; interpretation and report, when we prepare Thin Prep slides from a fine needle aspiration specimen. And can we continue to use the FNA performance codes when we perform an FNA since the codes have moved to the surgery section of CPT 2002?

A: It would be inappropriate to report 88108 in addition to 88173 for Thin Prep slides from an FNA. Code 88173 should be used to report all FNA definitive interpretations, including the preparation of direct smears or liquid-based slide preparation method, or both.

Because codes 88170 and 88171 have moved to the surgery section in CPT 2002, superficial FNAs are reported using code 10021, Fine needle aspiration; without imaging guidance and FNAs performed with imaging guidance are coded using 10022, Fine needle aspiration; with imaging guidance. The CPT book says, “It is important to recognize that the listing of a service or procedure and its code number in a specific section of this book does not restrict its use to a specific specialty group.” Therefore, pathologists and any other physicians performing an FNA procedure, therefore, may use the appropriate FNA code from the surgery section.

The code for immediate determination of adequacy (88172) and definitive interpretation and report (88173) remain in the pathology section of CPT 2002. Code 88172 may be reported by the pathologist, irrespective of who performs the aspiration on the patient.

Q: As a Cytopathologist, can I use 88141, Cytopathology, cervical or vaginal (any reporting system); requiring interpretation by physician, to review the negative Pap tests of women who are at high risk for vaginal or cervical cancer?

A: Physician interpretation code 88141 should be used only if a Pap test is abnormal, that is, it shows malignant cells or an epithelial cell abnormality; shows reactive cellular changes that may simulate an epithelial cell abnormality, such as repair, radiation effect, and cellular changes associated with viral infection; or if the laboratory’s screening personnel suspect an abnormality. In such cases, the pathologist must review and interpret the Pap test.

The manual rescreening codes in CPT (88143, 88153, and 88165) can be used to enhance clinical decision-making if the rescreening is finished before the Pap test report is issued. These codes, however, do not describe a physician review and interpretation. The codes also cannot be used for quality assurance or quality control reviews such as the mandatory 10% rescreening of normal Pap tests required by CLIA. It would be appropriate to use the manual screening codes for rescreening Pap tests of patients at high risk for cervical or vaginal cancer when the patient’s attending physician requests rescreening. If the screening or rescreening revealed that the Pap test was abnormal or if the laboratory screening personnel suspected an abnormality, the pathologist’s interpretation would be coded separately using 88141.

Frequently asked questions about CPT are published bimonthly in “Capitol Scan.” This addition to CAP TODAY is a product of the CAP Economic Affairs Committee.

The codes and descriptions listed here are from Current Procedural Terminology, a copyrighted publication of the American Medical Association. To purchase CPT books, call the AMA at (800) 621-8335.