Please compare the claim's date of adjudication to the range of the edit in question. Prior versions, if any, can be found below. Subject: Cytopathology, Cervical or Vaginal with Evaluation and Management Services Edit #: 299 Effective Date: 8/7/2009-12/31/2099 Status: Current Last Review Date: 4/9/2009 Edit 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). Page 1 of 6
CODE RULE CODE 88141+ 88142 88143 88147 88148 88150 88152 88153 88154 88155+ 88164 88165 88166 88167 88174 88175 Redundant/Mutually Exclusive 99201 99202 99203 99204 99205 99211 99212 99213 99214 99215 99241 99242 99243 99244 99245 99304 99305 99306 99307 99308 99309 99310 99315 99316 99318 99324 99325 99326 99327 99328 99334 99335 99336 99337 99341 99342 99343 99344 99345 Page 2 of 6
99347 99348 99349 99350 99381 99382 99383 99384 99385 99386 99387 99391 99392 99393 99394 99395 99396 99397 99450 99455 99456 Rationale for Edit: Anthem Central Region bundles 88141-88155, 88164-88167, 88174-88175 as redundant/mutually exclusive with 99201-99215, 99241-99245, 99304-99316, 99318, 99324-99337, 99341-99350, 99381-99397 or 99450-99456. In most cases when a family physician, internist or obstetrician/gynecologist submits a cytopathology/pap smear code they are not the physicians preparing and/or interpreting the pap smear, they are the physicians who obtained the specimen. A pathologist preparing and interpreting and writing the report of the cytopathology/pap smear must bill for this service. If 88141-88155, 88164-88167 or 88174-88175 is submitted with evaluation and management services 99201-99215, 99241-99245, 99304-99316, 99318, 99324-99337, 99341-99350, 99381-99397 or 99450-99456--only the evaluation and management service will reimburse. A pathologist should submit for the cytopathology/pap smear service (88141-88155, 88164-88167 or 88174-88175. Prior Version(s), if any, of this edit can be found below Please compare the claim's date of adjudication to the range of the edit in question. Prior versions, if any, can be found below. Page 3 of 6
Subject: Cytopathology, Cervical or Vaginal with Evaluation and Management Services Edit #: 299 Effective Date: 12/31/2001-8/6/2009 Status: Prior Last Review Date: 09/20/2001 Edit 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, 99271-99275, 99301-99316, 99321-99333, 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). CODE RULE CODE 88141+ Redundant/Mutually 99201 Page 4 of 6
88142 88143 88147 88148 88150 88152 88153 88154 88155+ 88164 88165 88166 88167 88174 88175 Exclusive 99202 99203 99204 99205 99211 99212 99213 99214 99215 99241 99242 99243 99244 99245 99271 99272 99273 99274 99275 99301 99302 99303 99311 99312 99313 99321 99322 99323 99331 99332 99333 99341 99342 99343 99344 99345 99347 99348 99349 99350 99381 99382 99383 Page 5 of 6
99384 99385 99386 99387 99391 99392 99393 99394 99395 99396 99397 99450 99455 99456 Rationale for Edit: Anthem Central Region bundles 88141-88155, 88164-88167, 88174-88175 as redundant/mutually exclusive with 99201-99215, 99241-99245, 99271-99275, 99301-99311, 99321-99333, 99341-99350, 99381-99397 or 99450-99456. In most cases when a family physician, internist or obstetrician/gynecologist submits a cytopathology/pap smear code they are not the physicians preparing and/or interpreting the pap smear, they are the physicians who obtained the specimen. A pathologist preparing and interpreting the cytopathology/pap smear must bill for this service. Anthem does not reimburse for cytopathology/pap smears when submitted by any other type of provider than a pathologist. but will make the cytopathology/pap smear service incidental or a visit edit to some evaluation and management services. If 88141-88155, 88164-88167 or 88174-88175 is submitted with evaluation and management services 99201-99215, 99241-99245, 99271-99275, 99301-99311, 99312-99633, 99341-99350, 99381-99397 or 99450-99456--only the evaluation and management service will reimburse. A pathologist should submit for the cytopathology/pap smear service (88141-88155, 88164-88167 or 88174-88175. Page 6 of 6