Academy Exchange

Could I get some help with billing/coding on anal PAP? I hope to offer this, right now doing DRE which seems insufficient. It seems the cytology test is not covered under Ryan White. I would like to provide cost info to those patients, as well as utilize the best billing codes for our patients with other insurance. My billing folks have stated I need the exact lab codes if we want to confirm the cost of these tests.  

Do any of these numbers look familiar? I am grateful for any help.

LAB: anal rectal cytology 009160, 10676, 751, 4099992

Anal rectal hrHPV 508005, 92807, 906739, misc 91826

The other codes I have are as follows: 

CPT 88104: fluid washing

CPT  88112: Fluid requiring thin layer preparation

ICD-10 codes: 

Z12.12 malignant neoplasm rectum screen

Z11.51 HPV screen

B20: HIV

Thank you for your expertise. It is much appreciated. 

Barbara Hart APRN

Hi Barbara:

Your codes look good, but you can also use these 2 ICD-10 codes: 

1. Anal dysplasia K62.82
2. High risk HPV B97.7

I would also add either HIV diagnosis (B20) or PrEP dx (Z79.899 for "on PrEP") or whatever the code is for the diagnosis that qualifies that person for anal cancer screening (ie. h/o cervical dysplasia, h/o organ transplant on immunosuppressives, etc).  

Unfortunately, there is no "screening for anal cancer" code, so your "screening for rectal cancer" is the closest one; I use it sometimes if I don't know for sure if whether that person has High risk HPV yet or anal dysplasia yet. I also order a high risk HPV test with the Pap smear as well, and you have the test codes for those already.

It sounds like you have all of the information, though, for the most part, so good job on that!  Keep in mind, insurance coverage will differ based on whatever insurance the patient has, so you may want to keep a list for yourself as you learn the coverage for each insurance plan.  You'll learn quickly which folks are covered (Ryan White, Medicaid, etc) vs which ones aren't (private insurances). 

You might also want to consider taking an HRA course with IANS (International Anal Neoplasia Society):  iansoc.org

I would make sure that you have HRA capabilities in your city before you start screening people, too.  Hope that helps!

James