What type of Pap test should you order?


Description:
There are two types of Pap Tests that can be ordered on our laboratory requisition form. The clinical information provided by the physician’s office determines which type of Pap Test will be billed.

SCREENING PAP

Low Risk
The patient may be there for her annual exam, but if she has had an abnormal Pap withing the past three years, the Pap should be coded as being diagnostic.

Low Risk - Clinical Information

• Routine screening Pap
• No signs or symptoms
• No previous diagnostic Pap for the past three years

High Risk
Billed as a screening Pap, but insurance carrier will usually pay one per year since there is a reason to keep an eye on this case.

High Risk - Clinical Information

• Early onset of sexual activity (under 16 yrs)
• Multiple sexual partners (5 or more in lifetime)
• History of STD which may include HIV
• Less than 3 negative or no Pap Testing within the past 7 years
• Daughters of women who took (DES) during pregnancy

DIAGNOSTIC PAP - Clinical Information

• Current gynecological signs or symptoms
• Past medical history of abnormal Pap within th past three years.

The patient’s insurance company may not have coverage for both types of Pap Tests. If the referring clinician asks us to change the diagnosis and rebill the insurance carrier, we must have this request in writing. Your request will be shared with the insurance company to explain why we are changing the original diagnosis code. In addition, the clinician will need to have documentation in the patient’s chart that will support this change in diagnosis.

If our records indicate that the patient has had an abnormal Pap within the past 3 years, we are obligated to bill the Pap Test as diagnostic and cannot change the diagnosis to routine, even at the request of the physician’s office.