CPT Codes for Pap Smears: Preparation, Screening, Rescreening & Reporting

Pap smear, a vital cervical cancer screening test, involves collecting cervical and vaginal cells examined under a microscope to detect any potential abnormalities or malignancies. In the United States, the introduction of the Pap test has significantly reduced mortality rates due to cervical cancer. This article presents a detailed, in-depth analysis of CPT codes related to Pap smears to help healthcare providers comprehensively understand their medical billing requirements.

CPT Codes for Pap Smears: Considerations

CPT codes for Pap smears cover various aspects of the procedure: specimen collection and preparation, screening methods, rescreening methods, and reporting systems. Additionally, some codes specifically pertain to the interpretation of abnormal results and the involvement of a qualified physician, such as a pathologist, in the process.

Specimen Collection and Preparation

Labs collect Pap smear samples using different techniques, such as conventional smear or liquid-based cytology.

CPT codes assigned to these methods vary according to the collection and preparation process:

• Conventional Pap smear: Codes 88142-88153
• Liquid-based Pap smear (e.g., ThinPrep or SurePath): Codes 88142-88153
• The Bethesda System: Codes 88164-88167
• Automated thin layer preparation: Codes 88174-88175

Screening Methods

Two primary screening techniques are available for analyzing Pap smear slides: manual and automated screening.

CPT codes differ according to the screening method used:

• Manual screening (under physician supervision): Codes 88150, 88152, 88153, 88164, 88165, 88166, 88167
• Automated screening (under physician supervision): Codes 88147, 88148

Rescreening Methods

Sometimes, laboratories may necessitate slide rescreening, necessitating the consideration of additional CPT codes:

• Manual rescreening: Codes 88150, 88152, 88153, 88164, 88165, 88166, 88167
• Computer-assisted rescreening: Codes 88152, 88166, 88167

Reporting Systems

Different reporting systems in laboratories are another factor contributing to varied CPT codes:

• Any reporting system: Codes 88142-88153, 88174-88175
• The Bethesda System: Codes 88164-88167

Interpretation of Abnormal Results

CPT code 88141 refers to the professional interpretation by a qualified physician for an abnormal Pap smear result.

Rescreening or Review Using Cell Selection

CPT code 88167 is specified for manual screening and computer-assisted rescreening using cell selection and review under a physician’s supervision.

Medicare Billing for Pap Smears: HCPCS Codes

Medicare billing requires healthcare providers to use HCPCS (Healthcare Common Procedure Coding System) codes instead of CPT codes for Pap smear tests for beneficiaries receiving a screening test instead of a diagnostic test. Like CPT codes, HCPCS codes have separate categories for the technical aspect of the Pap test and professional interpretation:

• P3000: Screening Pap smear collection and preparation by a technician under a physician’s supervision.
• P3001: Interpretation of screening Pap smears by a physician – applicable for up to three smears.
• Q0091: The act of obtaining the Pap smear cervical or vaginal specimen, preparing it, and transferring it to the laboratory.
• G-codes (G0123-G0124, G0141-G0148): These codes pertain to automated screening, manual rescreening, and cytotechnologist screening, with or without a physician’s supervision.

Modifiers

There are a few situations where modifiers may be necessary to provide accurate and complete information to the insurance payer when billing pap smears

Modifier 25

Description: Significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified healthcare professional on the same day of the procedure or other service.

Modifier 25 is used when a patient receives an Evaluation and Management (E/M) service and a Pap smear during the same encounter.

By appending the 25 modifier to the E/M service code, healthcare providers indicate that the E/M service was separate and distinct from the Pap smear procedure. This helps in justifying the billing of both procedures during the same encounter.

Example: A patient presents with symptoms of a vaginal infection and requires a routine Pap smear. The healthcare provider evaluates the patient’s symptoms, prescribes medication, and performs a Pap smear.

In this case, the E/M code (e.g., 99213) is billed with the 25 modifier and the appropriate CPT code for the Pap smear.

Modifier 59

Description: Distinct procedural service.

The 59 modifier indicates that two procedures or services, which are usually not billed together, were performed separately and distinctly on the same day. This modifier should be used cautiously as inappropriate use may trigger payer scrutiny or an audit.

Example: A patient receives a Pap smear for cervical cancer screening and an endometrial biopsy for abnormal uterine bleeding. Although both procedures involve the cervix, they are separate and distinct, targeting different health issues.

In this case, the 59 modifier should be appended to the CPT code for the endometrial biopsy to indicate that it is a distinct service from the Pap smear.

Modifier 76

Description: Repeat procedure by the same physician.

The 76 modifier indicates that a procedure or service was repeated on the same day by the same healthcare provider. This can occur if the initial Pap smear collection was inadequate and required a repeat sample during the same visit.

Example: A patient has an unsatisfactory Pap smear result due to an insufficient number of cells. The healthcare provider will perform another Pap smear during the same encounter to obtain an adequate sample.

The second Pap smear CPT code should be billed with the 76 modifier to signify the repeat procedure.

Examples

Below are clinical examples of cases when the CPT codes for pap smears should be billed.

Example 1: Routine Pap Smear

A 35-year-old female patient visits her primary care physician for an annual well-woman exam. During the visit, the physician performs a routine Pap smear.

In this case, the appropriate cpt code for the Pap smear (e.g., 88142) should be billed along with the annual gynecological examination HCPCS code S0612.

Example 2: Pap Smear and E/M Service with Modifier 25

A 30-year-old female patient presents with symptoms of a urinary tract infection and asks for her routine Pap smear. The physician evaluates her symptoms, prescribes an antibiotic, and performs a Pap smear.

In this case, the E/M service code (e.g., 99213) should be billed with modifier 25 and the appropriate CPT code for the Pap smear (e.g., 88142).

Example 3: Pap Smear with HPV Co-testing

A 43-year-old female undergoes a routine Pap smear with HPV co-testing.

The appropriate cpt code for the Pap smear (e.g., 88142) should be billed along with the corresponding cpt code for the HPV test (e.g., 87624).

Example 4: Unsatisfactory Pap Smear, Repeat Sample with Modifier 76

A 32-year-old female has a Pap smear, but the specimen was unsatisfactory due to insufficient cellularity. The physician decides to perform another Pap smear during the same visit.

In this case, the second Pap smear cpt code should be billed with modifier 76 to indicate a repeat procedure (e.g., 88142-76).

Example 5: Diagnostic Pap Smear for a Patient with a History of Abnormal Pap Smears

A patient with a history of abnormal Pap smears visits her gynecologist for a diagnostic Pap smear.

The appropriate CPT code for the diagnostic Pap smear (e.g., 88141) should be billed.

Example 6: Pap Smear with Endometrial Biopsy (Modifier 59)

A female patient experiencing abnormal uterine bleeding undergoes a Pap smear for cervical cancer screening and an endometrial biopsy to determine the cause of the bleeding.

The provider should bill the Pap smear cpt code (e.g., 88142) and the endometrial biopsy code (e.g., 58100) with a 59 modifier.

Example 7: Abnormal Pap Smear with Colposcopy

A patient has an abnormal Pap smear result, and her healthcare provider performs a colposcopy for further evaluation.

The provider should bill the cpt code for the Pap smear interpretation (e.g., 88141) and the cpt code for the colposcopy (e.g., 57452).

Example 8: Pap Smear Followed by Loop Electrosurgical Excision Procedure (LEEP)

A patient with a history of abnormal Pap smears undergoes a diagnostic Pap smear, followed by a LEEP (loop electrosurgical excision procedure) to remove abnormal cells.

In this case, the provider should bill the CPT code for the diagnostic Pap smear (e.g., 88141) and the CPT code for the LEEP procedure (e.g., 57461).

Example 9: Liquid-Based Pap Smear with HPV Test

A 54-year-old female patient undergoes a routine liquid-based Pap smear and an HPV test.

The appropriate CPT code for the liquid-based Pap smear (e.g., 88142) should be billed, along with the CPT code for the HPV test (e.g., 87624).

Example 10: Pap Smear and IUD Insertion with Modifier 59

A patient visits her healthcare provider for a routine Pap smear and has an intrauterine device (IUD) inserted for contraception during the same appointment.

The provider should bill the CPT code for the Pap smear (e.g., 88142) and the CPT code for the IUD insertion (e.g., 58300) with a 59 modifier.