By Amy Wright, CCP-AS, CPC-H, CCP-H, CPC, CCP, CMBS

The American Cancer Society (ACS) recommends annual screening if conventional Pap testing is used and screening every 2 years for liquid-based testing. The frequency of screening can be reduced to every 2 to 3 years at age 30 for women who have three normal consecutive Pap test results (unless there is a history of DES exposure or immunosuppression). Testing can be done as early as age 9 years old through age 26 years old.  Let's talk first about the vaccinations:

Administration:

HPV vaccines should be administered in a 3-dose schedule, with the second dose administered 1 to 2 months after the first dose, and the third dose 6 months after the first dose. The minimum interval between the first and second doses of vaccine is 4 weeks. The minimum interval between the second and third doses of vaccine is 12 weeks. The minimum interval between the first and third doses is 24 weeks.  HPV vaccines, used for billing purposes, are 90649 for Gardasil (Merck) and 90650 for Cervarix (GSK) plus administration codes for each vaccine (90460 immunization administration through 18 years of age, 90461 each additional vaccine) with Dx V04.89. Patients 9-20 years of age.

Reimbursement:

These services will be paid at a maximum estimate rate of $149.33 for each vaccine in the 3-dose series.  For females ages 21-26, all providers are eligible for a maximum estimate rate of $149.33 for each vaccination in the 3-dose series. These services should be billed using CPT code 90649 with the modifier SL (State Supplied Vaccine).  For the counseling with the HPV vaccine, I would look at 99401 and V65.45 and use these in addition to the admin and serum codes. Just note that 99401 is for 15 minutes.

Entering Charges:

As for the vaccination at a problem visit, you should be attaching the problem Dx (EX: Abnormal Pap smear cervix 795.0x) to your E&M code and only use the V04.89 code for the admin and serum codes for the vaccination mentioned above.

Any lab work for the HPV Detection and Identification is billed using codes 87620-87622 with Dx V73.81 depending on the technique and qualification in which the physician would choose.  The most common lab code is 87621.

If done with Cytopathology (liquid-based Pap test), use CPT code 88142, screening and rescreening 88143 (reimbursement for these two codes per Medicare fee schedule is $27.85).  Screening by automated system 88174 (reimbursement is about $29.37 per Medicare fee schedule), screening by automated system and rescreening 88175 (reimbursement is about $35.30 per Medicare fee schedule).  Dx V73.81.  If doing a conventional Pap test, use CPT code 88164 (reimbursement is about $14.53 per Medicare fee schedule).
Example:  If doing a GYN Cytology with the HPV, you would code 88142 with Dx V72.31 and 87621 with Dx V73.81.  If doing a Preventive visit, GYN Cytology and HPV, you would code Preventive Medicine Service E/M code 99381-99397 (age depending) plus 88142 both codes with Dx V72.31, 87621 with Dx V73.81.

Amy Wright, CCP-AS, CPC-H, CCP-H, CPC, CCP, CMBS, acts as a Coder Educator for CHI KentuckyOne Health and is a partner with Advanced Medical Solutions, Inc. as a Private Coding Instructor.  She also assists with Remote Coding through MedSave USA. Amy consults with healthcare providers regarding billing, coding, and operations as well as performs coding and documentation reviews.  Amy can be reached on LinkedIn or at mousie1226@gmail.com