Your CPT Questions

Reprinted from April 2004 CAP TODAY

Q: What is the correct CPT code for manual immunohistochemistry microscopy when scoring under 0, 1+, 2+, 3+ for HER2/neu or when estimating the percentage of nuclei staining positive for estrogen receptor/progesterone receptor?

A: At present, to report quantitative/semiquantitative immunohistochemistry performed by manual methods, as well as nonautomated qualitative/semiquantitative immunohistochemistry reported as zero to 3+, use CPT code 88342, Immunohistochemistry (including tissue immunoperoxidase), each antibody. Code 88361, Morphometric analysis; tumor immunohistochemistry (eg, Her-2/neu, estrogen receptor/progesterone receptor) quantitative or semiquantitative, which did not specify the methodology, was valued using computer-assisted immunohistochemistry analysis.

CPT is addressing the issue of coding for manual versus computer-assisted methodology, and future editions should clarify codification in this area.

Q: Is it appropriate to bill using code 88141 if a patient had two previous abnormal Pap smears, then receives a Pap test result that does not detect abnormalities, but because of the patient’s history, the case is referred for physician interpretation and the pathologist also determines the smear is normal?

A: High-risk smears alone do not qualify for physician review. Only when a screening or diagnostic Pap test shows abnormal results, such as epithelial cell abnormality, or is referred for benign cellular changes should the pathologist interpret the smear.

Medicare requires the use of HCFA Common Procedure Coding System, or HCPCS, level II codes to report Pap smear screenings. In addition to the screening smear code, use HCPCS code G0124, Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician, to report a screening Pap test referred for physician interpretation. A physician interpretation of an abnormality found in a diagnostic Pap test should be reported with CPT code 88141, Cytopathology, cervical or vaginal (any reporting system); requiring interpretation by physician, in conjunction with the appropriate diagnostic test code.

In the absence of signs or symptoms of disease, only the appropriate screening CPT or HCPCS level II code should be reported.

The codes and descriptions listed here are from Current Procedural Terminology, 4th ed., CPT 2003. CPT 2003 is copyrighted by the American Medical Association. To purchase CPT books, call the AMA at (800) 621-8335.