tci Medicare Compliance & Reimbursement - 2008 Issue 22

Reader Question: Know HPV Coverage Rules When Billing For The Lab's Side

Hint: Report 795.05 only when the test is positive Question: I am in a laboratory setting. For a patient whose thin-prep Pap test showed LGSIL, our lab performed low-risk and high-risk HPV DNA probe testing, with results positive for low risk and negative for high risk. What are the CPT and ICD-9 codes for the HPV testing? Answer: The diagnosis code for ordering the human papillomavirus (HPV) tests is the Pap diagnosis 795.03 (Papanicolaou smear of cervix with low-grade squamous intraepithelial lesion [LGSIL]) because that is the Pap test results that you indicate. Coverage issues: The American...

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