Image-Guided Pap with Age-Based Screening with CT/NG, Trichomonas

Test Code

91386

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

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 (CPT code(s): 87491, 87591), and Trichomonas vaginalis ("trich" or TV), Qualitative TMA, Pap Vial (CPT code(s): 87661) will also be performed.

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). CT/NG RNA, TMA (CPT code(s): 87491, 87591), and TV, Qualitative TMA, Pap Vial (CPT code(s): 87661) will also be performed.

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). CT/NG RNA, TMA (CPT code(s): 87491, 87591), and TV, Qualitative TMA, Pap Vial (CPT code(s): 87661) will also be performed.

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

For instructions refer to
//www.questdiagnostics.com/dms/Documents/Other/Specimen_Collection_and_Transport_Guide_2019.pdf

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

Trich ThinPrep Pap Vial
Room temperature: 30 days
Refrigerated: 30 days
Frozen: Unacceptable

Trich ThinPrep Pap 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/Trich: 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 will perform like test code 91384 but will always add Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis ("trich" or TV) testing to the Pap. Specifically, testing will occur 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, CT/NG and TV 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. Additionally, CT/NG and TV 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. Additionally, CT/NG and TV will be performed.
• Patients falling outside of the above age ranges, or without a date of birth, will receive an Image-guided Pap. Additionally, CT/NG and TV will be performed.

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

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.