Wednesday, October 19, 2016

CPT code 88175, 88155, 88164, 88165, 88150 - Cervical Cytology Value Set

Procedure  88175 - Cytopath c/v auto fluid redo


Category Inclusions Cost


Supplies Liquid based Pap test Stains and Fixatives Preparation Liquid based pap processor for automated screening, personnel, disposal of waste Evaluation Cytotechnologist and support salaries, pathologists salary Indirect Expenses Client service, record keeping, reports, liability, training, storage, occupancy and institutional overhead Total

88155 Cytopathology, slides, cervical or vaginal definitive hormonal evaluation


88164 Cytopathology, slides, cervical or vaginal (the Bethesda System); manual screening under physician supervision

88165 With manual screening and rescreening under physician supervision

Coding Guidelines

1. Determine if the test is screening or diagnostic.

2. Choose the code that best describes the method of testing, i.e. Thin Prep, Bethesda, or other.

Summary Procedure  section for cervicovaginal cytology (c/v): 88150-88154- c/v, conventional smear, “other” (non-Bethesda) reporting system 88164-88167- c/v, conventional smear, Bethesda reporting system 88142-88143- c/v, liquid-based cytology, any reporting system 88174-88175- c/v, liquid-based cytology, computer-assisted screening, any reporting system

3. Use procedure code 88199 only to indicate the service was provided with a system that is considered investigational. When services are provided by a method that is not FDA-approved, the entire service is considered non-covered.

a. Liquid based monolayer cell preparation technique is considered “investigational” when provided with systems that have not received FDA approval.

b. Do not list the pap test procedure code. List the description of the service “Investigational - (name of system,)”, in Box 19 of the HCFA 1500 form or on an attachment. This information is placed in the Narrative Record (HA0 record) for EMC submitters.

4. Liquid based prep services are no longer paid in addition to a Pap smear performed by another method, instead, they are available as another method of performing the test.


Cervical Cancer Screening Procedure Codes 88141-88143, 88147, 88148, 88150, 88152-88154, 88164-88167, 88174, 88175 HCPCS G0123, G0124, G0141, G0143-G0145, G0147, G0148, P3000, P3001, Q0091 UB Rev Codes 0923 HPV Procedure Codes

87620-87622 LOINC Codes

21440-3, 30167-1, 38372-9, 49896-4, 59420-0 Women 21-64 years of age with one or more Pap tests within the last 3 years OR for women 30-64 years of age, a cervical cytology and human papillomavirus (HPV) co-testing with in the last 5 years. Notation of Pap test located in progress notes MUST  include the lab results in order to meet NCQA® requirements.

Cervical cytology and human papillomavirus test must be completed four or less days apart in order to qualify for every 5 years testing.

Laboratory Services

Medicaid family planning service providers must document all laboratory services ordered in the client’s medical record as medically necessary and reference an appropriate diagnosis. Any test specimen sent to a laboratory for interpretation should not be billed on the family planning provider’s claim. The laboratory bills Texas Medicaid directly for the tests the laboratory performs. All providers of laboratory services must comply with the rules and regulations of the Clinical Laboratory Improvement Amendments (CLIA). Providers not complying with CLIA will not be reimbursed for laboratory services. Only the office or lab actually performing the laboratory test procedure and holding the appropriate CLIA certificate may bill for the procedure.

A provider that does not perform the laboratory procedure may be reimbursed one lab-handling fee per day, per client, unless multiple specimens are obtained and sent to different laboratories. Procedure code 99000 with modifier FP is paid for handling and/or conveyance of the specimen for transfer from the physician’s office to a laboratory.

Handling fees are not paid for Pap smears or cultures. When billing for Pap smear interpretations, the claim must indicate that the screening and interpretation were actually performed in the office by using the modifier SU, procedure performed in physician’s office (e.g., 88150- SU).

Providers must forward the client’s name, address, Medicaid number, and a family planning diagnosis with any specimen, including Pap smears, to the reference laboratory so the laboratory may bill the WHP for its family planning lab services.

When family planning test specimens, such as Pap smears, are collected, providers must direct the laboratory to indicate that the claim for the test is to be billed as a family planning service (i.e., procedure must be billed with a WHP qualifying diagnosis code). Refer to: “Diagnosis Codes” on page O-3 for a list of WHP qualifying diagnosis codes. Laboratory services may be submitted using the following procedure codes. Appropriate documentation must be kept in the client’s record.

Procedure Codes

80061 81000 81001 81002 81003 81015 81025 82947 82948 84702 84703 85013 85014 85018 85025 85027 86318 86580 86592 86689 86701 86703 86762 86803 8690086901 87070 87086 87088 87102 87110 87205 87210 87220 87340 87480 87490 87491 87510 87590 87591 87621 87660 87797 87800 87810 87850 88141 88142 88150 88164 88175 Q0111

Procedure code 87797 will be denied if submitted for the same date of service as procedure code 87800. Providers are reminded to code to the highest level of specificity with a diagnosis to support medical necessity when submitting procedure code 87797. Claims may be subject to retrospective review if they are submitted with diagnosis codes that do not support medical necessity. If more than one of procedure codes 87480, 87510, 87660, or 87800 is submitted by the same provider for the same client with the same date of service, all of the procedure codes will be denied. Procedure codes 87480, 87510, 87660, 87797, and 87800 are not payable in the inpatient hospital setting.



Code Group 2 (requires a diagnosis code from list below):

88141 – 88143, 88147, 88148, 88150, 88152 – 88155, 88164 – 88167, 88174, 88175

Diagnosis Code(s) Code Group 2:

• ICD-9: V70.0, V72.31, V72.32, V76.2

• ICD-10: Z00.00, Z00.01, Z01.411, Z01.419, Z12.4




Code Code Type Description: Pap test

88141  Cytopathology, cervical or vaginal, interpretation by physician

88142  Cytopathology, cervical or vaginal, manual screening under physician supervision

88143 Cytopathology, cervical or vaginal, manual screening and rescreening under physician supervision

88147 Cytopathology smears, cervical or vagina, screening by automated system under physician supervision

88148 Cytopathology smears, cervical or vagina, screening by automated system with manual rescreening under physician supervision

88150 Cytopathology, slides, cervical or vaginal, manual screening, under physician supervision

88152 Cytopathology, slides, cervical or vaginal, manual screening and computer assisted rescreening, under physician supervision

88153 Cytopathology, slides, cervical or vaginal, manual screening and rescreening under physician supervision

88154 Cytopathology, slides, cervical or vaginal manual screening, computer assisted rescreening, under physician supervision

88155 Cytopathology, slides, cervical or vaginal, definitive hormonal evaluation

88164 Cytopathology, slides, cervical or vaginal, manual screening, under physician supervision

88165 Cytopathology, slides, cervical or vaginal, manual screening and rescreening, under physician supervision

88166 Cytopathology, slides, cervical or vaginal, manual screening and computer assisted rescreening, under physician supervision

88167 Cytopathology, slides, cervical or vaginal, manual screening and computer assisted rescreening using cell selection, under physician supervision

88174 Cytopathology, cervical or vaginal collected in preservation fluid, automated thin layer preparation, screening by auto system, under phys super

88175 Cytopathology, cervical or vaginal collected in preservation fluid, screening by automated system, and manual rescreening, under physician super

G0123 Screening Cytopathology, cervical or vaginal, automated thin layer preparation, screening by cytotechnologist under physician supervision

G0124 Screening Cytopathology, cervical or vaginal, automated thin layer preparation, requiring physician interpretation

G0141 Screening Cytopathology, cervical or vaginal, automated thin layer preparation, with manual rescreening, requiring physician interpretation

G0143 Screening Cytopathology, cervical or vaginal, auto thin layer preparation, with manual screening/ rescreening by cytotechnologist, under phys super

G0144 Screening Cytopathology, cervical or vaginal, automated thin layer preparation, with screening by automated system, under physician supervision

G0145 Screening Cytopathology, cervical or vaginal, automated thin layer prep, with screening by auto system w manual rescreening under phys super

G0147  Screening Cytopathology smears, cervical or vaginal, performed by automated system under physician supervision

G0148 Screening Cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening

P3000 Screening Papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision

P3001 Screening Papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician

Q0091 Screening Papanicolaou smear, obtaining, preparing and conveyance of cervical or vaginal smear to laboratory




Edit procedure code Guidelines

88141+ (Cytopathology, cervical or vaginal {any reporting system}; requiring interpretation by physician {list separately in addition to code for technical service), 88142 (Cytopathology, cervical or vaginal {any reporting system}, collected in preservation fluid, automated thin layer preparation; manual screening under physician supervision) 88143 (Cytopathology, cervical or vaginal {any reporting system; with manual screening and rescreening under physician supervision), 88147 (Cytopathology, smears, cervical or vaginal; screening by automated system under physician supervision), 88148 (Cytopathology smears, cervical or vaginal; screening by automated system with manual rescreening under physician supervision), 88150 (Cytopathology, slides, cervical or vaginal; manual screening under physician supervision), 88152 (Cytopathology, slides, cervical or vaginal; with manual screening and computerassisted rescreening under physician supervision), 88153 (Cytopathology, slides, cervical or vaginal; with manual screening and rescreening under physician supervision), 88154 (Cytopathology, slides, cervical or vaginal; with manual screening and computer-assisted rescreening using cell selection and review under physician supervision), 88155+ (Cytopathology, slides, cervical or vaginal, definitive hormonal evaluation {e.g., maturation index, karyopyknotic index, estrogenic index} {List separately in addition to code(s) for other technical and interpretation services}), 88164 (Cytopathology, slides, cervical or vaginal  {the Bethesda System}; manual screening under physician supervision), 88165 (Cytopathology, slides, cervical or vaginal {the Bethesda System}; with manual screening and rescreening under physician supervision), 88166 (Cytopathology, slides, cervical or vaginal {the Bethesda System}; with manual screening and computer assisted rescreening under physician supervision), 88167 (Cytopathology, slides, cervical or vaginal {the Bethesda System}; with manual screening and computer-assisted rescreening using cell selection and review with physician supervision), 88174 (Cytopathology, cervical or vaginal
{any reporting system}, collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision) and 88175 (Cytopathology, cervical or vaginal {any reporting system}, collected in preservative fluid, automated thin layer preparation; with screening by automated system and manual rescreening, under physician supervision) bundles with 99201-99215, 99241-99245, 99304-99316, 99318, 99324-99337, 99341-99350, 99381-99397 and 99450-99456 (Outpatient services, nursing facility services, domiciliary/rest home/boarding home or custodial care services, home services, preventive medicine services and special evaluation and management services).

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