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
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.