College of American Pathologists

  Pap test codes and QA...


Reprinted from June 1999 CAP TODAY

The laboratory community continues to have questions about the use of new Pap test codes for quality assurance activities, the College reports.

Regarding the physician interpretation code, 88141, the College said in a recent CAP TODAY article that “...considering the interpretation code terminology and the CLIA requirements, negative Pap tests that do not require a physician's interpretation, including those reviewed for quality assurance purposes, should not be coded with the physician interpretation code.” (See “HCFA scuttles site-of-service Pap smear plan,” February 1999, page 5.) Similar advice appeared earlier in the American Medical Association publication CPT Assistant.

Similarly, CPT ‘99 codes added in recognition of the potential to improve Pap test accuracy through double screening, either manually or with the aid of computer-assisted technology, should not be used to report quality assurance activities.

The double-screening codes are intended to cover initial screening and rescreening performed manually or with an automated system, such as PapNet or AutoPap. Laboratories may rescreen Pap tests, manually or with such a system, to enhance clinical decision-making. In these cases, the CPT codes for Pap test double screening can be used if the rescreening is finished before the Pap test report is issued.

Under CLIA, a laboratory “must establish a program that includes a review of slides from at least 10 percent of the gynecological cases interpreted negative for reactive, reparative, atypical, premalignant or malignant conditions.... The review must include negative cases selected at random from the total caseload and from patients or groups of patients identified as having high risk probability of developing cervical cancer... The review must be completed before reporting patient results on those cases selected.” The Food and Drug Administration has approved the use of PapNet for meeting the 10 percent quality assurance requirement, but only if the laboratory uses the system to review all negative cases. As laboratories consider when it is appropriate to use the new double-screening codes, a variety of approaches seem to be emerging. Some laboratories offering double screening do so only if the attending physician or patient requests it. Other laboratories report that they double screen all Pap tests unless asked not to do so. Some rescreen only highrisk cases.

The Health Care Financing Administration this year gave Medicare carriers the discretion to set payment rates locally for the double-screening codes and decide which of those codes to cover. The carriers will submit their data to HCFA for analysis later this year.

Not yet known is how the agency will address the coverage and payment issues surrounding the new codes. Also unclear is how private insurers will handle payment for the codes.