This was originally written back in April of 2016....
4/23/2016
Cervical Cancer Screening - Pap test results, definitions and ICD-10
A Cervical cancer screening
test, also known as a Pap (Papanicolaou test) is used to find abnormal changes
in the cells of the cervix. If abnormal
cells are found, those cells can potentially mutate into cancer cells within
the cervix. Cervical cancer
screening includes the Pap test and, some providers also perform an HPV (Human
Papilloma Virus) test.
When the provider performs
a screening or diagnostic Pap test, both tests use cells taken directly from
the cervix. The cells that are removed from the cervix, put into a special
liquid and sent to the laboratory for testing.
If only the Pap test is performed, the cells are reviewed and examined
to see if any “abnormal” cells are present with “normal cells”. When the HPV testing is performed, the cells
are then reviewed to see if the HPV virus is present within that sample. Most pathology labs will sample for 13 or 14
of the most common high-risk HPV types.
According to ACOG (The
American College of Obstetrics and Gynecology), the main cause of cervical
cancer is infection with HPV. Unfortunately, there are many types of HPV, and
some of the HPV infections are considered “high-risk” types. It has been determined that with the most
common cases of cervical cancer; most cervical cancers are narrowed down to two
high-risk types of HPV—type 16 and type 18. It is the abnormal cell types that can be
found with these screening tests. Abnormal
changes can range from mild to a full blown case of cervical cancer.
Pap tests are most commonly
procured at the time of the well woman exam, and are performed primarily as a
screening tool for cervical cancer.
However, with the Pap test, sometimes the cells from the vagina are
taken if the woman does not have a cervix.
Pathology Acronyms and Definitions
As coders, we must know and understand all definitions
that affect the diagnosis codes that we append to the procedure codes. It is extremely important that we do not
append an incorrect diagnosis to a patients’ medical record or billing. The acronyms for cervical cancer screening
tests are numerous. Many of these terms
have similar sounding verbiage, yet the definitions do not mean the same
things.
When reviewing the pathology documentation,
the term ASCUS, is commonly seen. This
acronym means “Atypical squamous cells of undetermined significance on
cytologic smear of cervix (ASCUS)”. Squamous intraepithelial lesion (SIL) is an acronym used to describe Pap test results.
“Squamous” refers to the type of cells that make up the
tissue that covers the cervix. SIL is not a diagnosis of pre-cancer or cancer. In ICD-10 the term SIL is not noted, however,
ICD10cm does refer to many of the other acronyms associated with pathology
cells and cell types that are found with the Pap test.
The
Pap test is most commonly performed as a screening test for changes to the
cells within the cervix, but can also be used as a diagnostic tool too. The changes
in cell types found on the cervix can be a possible pre-cursor to a cervical
cancer, or can be completely benign. If the changes in some of the cells cannot
be exactly diagnosed, or noted by how severe the changes are in cervical cells,
this would be documented on the pathology report as an ASCUS pap finding.
To
correctly code for an ASCUS pap we would look at the code of R87.610. (R87.610 Atypical squamous cells of undetermined
significance on cytologic smear of cervix (ASC-US). The R87 code set is part of the codes that
are symptoms, signs and abnormal clinical and laboratory findings. In addition to the ASCUS documentation on a
pap result, the terms LGSIL and HGSIL may also be found. LGSIL acronym stands for “Low grade squamous intraepithelial lesion on
cytologic smear of cervix” . The term HGSIL is for the notation of “High grade squamous intraepithelial lesion
on cytologic smear of cervix”.
Abnormal
cytological findings in specimens from female genital organs
Atypical squamous cells, cannot exclude HGSIL the
possibility that there have been changes in the cervical cells found that raise
concern for the presence of HGSIL.
Atypical glandular cells (AGC)—Glandular cells are
another type of cell that makes up the thin layer of tissue that covers the
inner canal of the cervix. Glandular cells also are present inside the uterus.
An AGC result means that changes have been found in glandular cells that raise
concern for the presence of pre-cancer or cancer.
If the term cervical
dysplasia is documented, this term indicates that abnormal cells were found
on the surface of the cervix. A cervical
dysplasia is classified as mild, moderate or severe, depending on the
appearance of the abnormal cells. Cervical dysplasia can disappear on its own
or, it can develop into a more malignant form such as a neoplasm/cancer. Cervical
dysplasia is also known as a Cervical Intraepithelial Neoplasia, or denoted as
CIN.
In ICD-10, if the term “mild cervical dysplasia” is
documented and/or the term CIN I the corresponding code in ICD-10cm is to be
coded to N87.0. If the term “moderate
cervical dysplasia” and/or CIN II is
documented, those terms correlate to be coded as N87.1. However, if the term “severe cervical
dysplasia” and/or CIN III is documented
, ICD-10cm guides us to the code set of D06.# and is denoted in ICD-10cm as a carcinoma
in situ of the cervix uteri. If the
provider did not specify if the dysplasia is mild, moderate or severe, then the
unspecified code of N87.9 should be chosen. If the documentation is noted to be severe,
then the code chosen in the D06’s needs to be specified as to endocervix,
exocervix, other parts of cervix, or unspecified. As you can see from the codes below a severe
dysplasia is considered to be a carcinoma, in situ; meaning it is contained
within the cervix .
D06.0 Carcinoma in situ of endocervix D06.1 Carcinoma in situ of exocervix D06.7 Carcinoma in situ of other parts of cervix
D06.9 Carcinoma in situ of cervix, unspecified
N87 Dysplasia of cervix uteri
N87.0 Mild cervical dysplasia N87.1 Moderate cervical dysplasia
Glandular cells are another type of cell that make up the
thin layer of tissue that covers the inner canal of the cervix. Atypical glandular cells (AGC) can also be
denoted on the pathology report, and those cells may be present in the specimen
that was procured at the time of the Pap test.
These glandular cells also are present inside the uterus. If a pap test denotes the patient has an AGC
result, this represents changes have been found in glandular cells, which raises the concern for the presence of pre-cancer
or cancer not only on the cervix, but a possibility of cancer cells that may be
present in the uterus.
If the
patient does have an abnormal cervical cancer screening (Pap) test result, the
patient may require further testing. The first line of treatment is most often
a repeat Pap test or a repeat Pap test and include testing for high-risk types
of HPV. Additional testing or procedures
are recommended as a follow-up to some abnormal test results. In addition to the Pap test, the provider may
want to perform a colposcopy, biopsy, and endocervical sampling. A colposcopy procedure is an examination of
the cervix with a magnifying device that includes the tools to take a more
in-depth sample of the cervix or targeted area on the cervix.
If
an area of abnormal cells is seen, the physician may decide to perform a cervical
or vaginal biopsy. An endocervical and possibly an endometrial
sample biopsy also may be done if the initial pap did show AGC. As with any screening or diagnostic testing,
follow up with the provider is crucial.
When
coding any of these tests, be sure that all results are clearly documented by
the provider. When coding for the
initial procurement of the pap test, the codes below would be used to bill for the procedure/procurement of the
pap specimen, and for connecting the diagnosis driver to the screening process through
the designation of an E&M code for the Wellness/well-woman exam.
CPT
codes 99384 - 99387 (new patient)
CPT
codes 99394 - 99397 (established patient)
ICD-10: Z12.4 Encounter for screening for
malignant neoplasm of cervix
HCPCS: Q0091 Screening Pap smear; obtaining, preparing and conveyance
of cervical or vaginal smear to laboratory
Note: The HCPCS Code
Q0091 is a HCPCS code
developed by Medicare for services provided to Medicare patients. Medicare allows payment of code Q0091 for the
collection of the pap specimen itself, and should only be reported if performed
as a screening process. The Q0091 is not
to be reported if the pap testing is performed for a diagnostic or medically
indicated reason.
In the table below, the most common CPT and HCPCS codes reported out by
the laboratory for testing
|
Code
Number
|
Description
|
|
CPT-4
|
|
|
87620
|
Infectious agent detection by nucleic acid (DNA or RNA);
papillomavirus, human, direct probe technique (Deleted 12-31-2014)
|
|
87621
|
Infectious agent detection by nucleic acid (DNA or RNA);
papillomavirus, human, amplified probe technique (Deleted 12-31-2014)
|
|
87622
|
Infectious agent detection by nucleic acid (DNA or RNA);
papillomavirus (HPV), human, quantification (Deleted 12-31-2014)
|
|
87623
|
Infectious agent detection by nucleic acid (DNA or RNA); Human
Papillomavirus (HPV), low-risk types (eg, 6, 11, 42, 43, 44) (New 01-01-2015)
|
|
87624
|
Infectious agent detection by nucleic acid (DNA or RNA); Human
Papillomavirus (HPV), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51,
52, 56, 58, 59, 68) (New 01-01-2015)
|
|
87625
|
Infectious agent detection by nucleic acid (DNA or RNA); Human
Papillomavirus (HPV), types 16 and 18 only, includes type 45, if performed
(New 01-01-2015)
|
|
88142
|
Cytopathology, cervical or vaginal, (any reporting system)
collected in preservative fluid, automated thin layer preparation, manual
screening under physician supervision (ThinPrep)
|
|
88143
|
Cytopathology, cervical or vaginal, (any reporting system)
collected in preservative fluid, automated thin layer preparation, 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
|
|
88152
|
Cytopathology, slides, cervical or vaginal, with manual screening
and computer-assisted 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
|
|
88166
|
Cytopathology, slides, cervical or vaginal, (Bethesda System);
with manual screening and computer-assisted rescreening under physician
supervision
|
|
88167
|
Cytopathology, slides, cervical or vaginal, (Bethesda System);
with manual screening and computer-assisted rescreening using cell selection
and review under 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
|
|
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
|
|
HCPCS (normally used for Medicare patients)
|
|
|
G0123
|
Screening cytopathology, cervical or vaginal (any reporting
system), collected in preservative fluid, automated thin layer preparation,
screening by cytotechnologist under physician supervision
|
|
G0124
|
Screening cytopathology, cervical or vaginal (any reporting
system), collected in preservative fluid, automated thin layer preparation,
requiring interpretation by physician
|
|
G0141
|
Screening cytopathology, smears, cervical or vaginal, performed
by automated system, with manual rescreening, requiring interpretation by
physician
|
|
G0143
|
Screening cytopathology, cervical or vaginal (any reporting
system), collected in preservative fluid, automated thin layer preparation,
with manual screening and rescreening by cytotechnologist under physician
supervision
|
|
G0144
|
Screening cytopathology, cervical or vaginal (any reporting
system), collected in preservative fluid, automated thin layer preparation,
with screening by automated system, under physician supervision
|
|
G0145
|
Screening 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
|
|
G0147
|
Screen 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
|
Wrapping
it up
As a coder, remember to code what you know, and do not assume a
correlation, or that similar “sounding” terms really mean the same thing. If in doubt, or the documentation does not
appear to be clear or is confusing, query the provider. Good patient care requires the provider to
accurately reflect the patient care via their documentation in the medical
record. Our job, as a coder, is to
correlate the coding and billing to reflect the medical that was documented and
provided by the physician. If you are
unsure about the coding guidelines utilize your resources such as CPT,
ICD-10cm, ICD-10pcs and HCPCS.
Lori-Lynne
A. Webb, CPC, CCS-P, CCP, CHDA, COBGC and ICD10 cm/pcs Ambassador/trainer is an
E&M, and Procedure based Coding, Compliance, Data Charge entry and HIPAA
Privacy specialist, with over 20 years of experience. Lori-Lynne’s coding specialty is OB/GYN
office & Hospitalist Services, Maternal Fetal Medicine, OB/GYN Oncology,
Urology, and general surgical coding.
She can be reached via e-mail at webbservices.lori@gmail.com or you can also find current coding information on her blog site: http://lori-lynnescodingcoachblog.blogspot.com/.
No comments:
Post a Comment