Image-Guided Pap with Age-Based Screening Protocols

Test Code
91384


CPT Codes
88175*<br><strong>*</strong>See below for age related testing and CPT codes<br><strong>This test is not available for California patient testing.</strong>

Includes
Patients aged 21-24: If the Pap result is ASC-US then the HPV mRNA assay will be performed at an additional charge (CPT code(s): 87624). Chlamydia trachomatis (CT)/Neisseria gonorrhoeae (NG) RNA, TMA will also be performed (CPT code(s): 87491, 87591).

Patients aged 25-29: If the Pap result is ASC-US then the HPV mRNA assay will be performed at an additional charge (CPT code(s): 87624).

Patients aged 30-65: If the Pap result is negative and the HPV mRNA screen (CPT code(s): 87624) is positive (detected), then HPV mRNA Genotypes 16, 18/45 will be performed at an additional charge (CPT code(s): 87625).

Pap results requiring physician interpretation will be performed at an additional charge (CPT Code(s): 88141; HCPCS: G0124).


Preferred Specimen
Pap sample collected in 1 ThinPrep® pap vial or pap sample collected in 1 SurePath™ pap vial


Minimum Volume
1 ThinPrep pap vial • 1 SurePath pap vial


Instructions


Transport Container
1 ThinPrep pap vial or 1 SurePath pap vial


Transport Temperature
Room temperature


Specimen Stability
SurePath Pap - SurePath Pap Vial
Room Temperature: 28 days
Refrigerated: 6 months
Frozen: Unacceptable

SurePath HPV - SurePath Pap Vial
Room temperature: 7 days
Refrigerated: 7 days
Frozen: Unacceptable

SurePath HPV - SurePath Preservative Fluid in Aptima® Transfer Tube
Room temperature: 7 days
Refrigerated: 7 days
Frozen: Unacceptable

SurePath CT/NG - SurePath Pap Vial
Room temperature: 4 days
Refrigerated: Unacceptable
Frozen: Unacceptable

SurePath CT/NG - SurePath Preservative Fluid in Aptima® Transfer Tube
Room temperature: 14 days
Refrigerated: 14 days
Frozen: Unacceptable

ThinPrep Pap
Room temperature: 42 days
Refrigerated: Unacceptable
Frozen: Unacceptable

HPV - ThinPrep Pap Vial
Room temperature: 30 days
Refrigerated: 105 days
Frozen: Unacceptable

ThinPrep Pap Vial in Aptima® Transfer Tube
Room temperature: 60 days
Refrigerated: 60 days
Frozen: 2 years

CT/NG - ThinPrep Pap Vial
Room temperature: 30 days
Refrigerated: 30 days
Frozen: Unacceptable

CT/NG - ThinPrep Pap Vial in Aptima® Transfer Tube
Room temperature: 14 days
Refrigerated: 30 days
Frozen: 1 year

Refer to local service area for specimen retention.


Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
ThinPrep vials received refrigerated or frozen • Swabs • Cervical swabs in Digene® HC cervical sampler • Digene® vials • SurePath vials without the head of the collection device(s) in the fluid • SurePath vials received frozen


Methodology
Pap: Microscopy with Computer-imaging
HPV/CT/NG: Transcription Mediated Amplification (TMA)

Setup Schedule
Set up: Mon-Sat; Report available: 5 days


Reference Range
See Laboratory Report


Clinical Significance
This new test code is designed to help clinicians order age-appropriate testing for cervical cancer screening and STIs. Based on the patient's age and on ACOG Practice Guidelines for cervical cancer screening and Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) screening, testing in addition to the Pap will be processed as follows:

• Patients aged 21-24: Patients will receive Image-guided Pap and, when the result is ASC-US, a high-risk HPV mRNA test will be performed. Additionally, testing for CT/NG will be performed.
• Patients aged 25-29: Patients will receive Image-guided Pap and, when the result is ASC-US, a high-risk HPV mRNA test will be performed.
• Patients aged 30-65: Patients will receive Image-guided Pap and a high-risk HPV mRNA test. When the Pap result is negative but the HPV mRNA screen is positive, Genotyping for HPV mRNA 16, 18/45 will be performed.
• Patients falling outside of the above age ranges, or without a date of birth, will receive an Image-guided Pap only.

Codes may include ThinPrep® or SurePath™ Image-guided Paps, HPV mRNA, CT/NG.


Performing Laboratory
Quest Diagnostics Nichols Institute Chantilly
14225 Newbrook Dr
Chantilly, VA 20153



The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.