College of American Pathologists

  Your CPT Questions


Reprinted from August 2002 CAP TODAY

Q: Is there a code or modifier I can use to report services provided outside the United States? Our lab would like to send tests to another country for processing. How can our lab bill the Medicare program when reporting the tests for in-country Medicare beneficiaries?

A: There is no code or modifier for reporting services provided outside the United States as Medicare does not pay for services provided in other countries.

The United States includes the 50 states, District of Columbia, Puerto Rico, Virgin Islands, Northern Mariana Islands, and, for the purposes of services rendered on a ship, the territorial waters adjoining the land areas of the United States.

Q: The new Bethesda 2001 reporting system contains an area under the specimen adequacy section that allows you to indicate whether a specimen was unsatisfactory for evaluation because it was rejected or not processed or because it was unsatisfactory for evaluation of epithelial abnormality. How should I code an unsatisfactory Pap test under the new Bethesda system?

A: A Pap test that is unsatisfactory because it was rejected or not processed should not be reported using a CPT code. If a specimen cannot be evaluated, then a CPT code should not be submitted. If a Pap slide, for example, is received unlabeled or was broken in transit to the lab, a CPT code should not be reported.

A Pap test that is processed and examined but was unsatisfactory for evaluation of epithelial abnormality may be reported using the appropriate Pap test code. The new Bethesda terminology identifying unsatisfactory Pap tests that were processed and examined can be used in the lab report as an auditable record that the specimen was processed and examined. If the laboratory, for example, received a conventional Pap smear that was processed and examined by a cytotechnologist but was found to be obscured by blood, the initial screening service would be reported with code 88164.

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.