Gynecologic Pap Test (Image-guided), Liquid-based Preparation

CPT: 88175
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Test Details

Limitations

Failure to obtain adequate ectocervical, endocervical, or vaginal cell population is suboptimal for evaluation. Excessive use of lubricating jelly on the vaginal speculum will interfere with cytologic examination and may lead to unsatisfactory Pap results.

Methodology

Image-guided liquid-based Pap test

Specimen Requirements

Volume

Entire vial

Minimum Volume

1 mL

Container

ThinPrep® vial or SurePath™ vial

Patient Preparation

Patient should avoid douches 48 to 72 hours prior to examination. Specimen should not be collected during or shortly after menstrual period. Excessive use of lubricating jelly will interfere with cytologic examination.

Collection

ThinPrep® Vial − Broom or Brush/Spatula:

Broom-like collection technique: Obtain a sample from the cervix using a broom-like device by inserting the brush portion into the cervical os and rotate the brush five times. Rinse the collection device in the PreservCyt® solution by pushing the brush into the bottom of the vial 10 times, forcing the bristles to bend apart to release the cervical material. As a final step, twirl the brush between the thumb and forefinger vigorously to release additional cellular material. Discard the collection device. Tighten the cap on the ThinPrep® vial so that the torque line on the cap passes the torque line on the vial.

Brush/spatula technique: Insert the brush into the endocervical canal until only the bottommost fibers are exposed. Slowly rotate the brush 1/4 to 1/2 turn in one direction. Do not over-rotate the brush. Then, rotate the brush in the PreservCyt® solution 10 times while pushing against the wall of the ThinPrep® vial. Swirl the brush vigorously to release additional material. Discard the brush. Obtain an adequate sample from the ectocervix using a plastic spatula. Swirl vigorously in the ThinPrep® vial 10 times and discard the spatula. Tighten the cap on the ThinPrep® container so that the torque line on the cap passes the torque line on the vial.

SurePath™ Vial: When using the SurePath™ vial, the cervical broom must be used for specimen collection. Insert the broom into the cervical os and rotate five times. Place the broom head into the CytoRich™ preservative fluid in the SurePath™ collection vial. Tightly cap the vial.

Storage Instructions

Maintain specimen at room temperature. Specimens must be processed for testing within 21 days of collection.

Causes for Rejection

Improperly labeled vial; specimen more than 21 days old (from collection date) in liquid-based preservative; specimen submitted in vial that expired according to manufacturer's label; frozen specimen

Clinical Information

Special Instructions

Include date of birth, Social Security number (or other identification number), previous malignancy, drug therapy, radiation therapy, last menstrual period (LMP), postmenopausal patient (PMP), surgery (including surgical biopsies), exogenous hormones, abnormal vaginal bleeding, abnormal Pap results, IUD, and all other pertinent clinical information on the cytology request form.

Note: In accordance with criteria established by CLIA, Pap tests will be referred for pathologist review if laboratory personnel suspect:

• Reactive or reparative cellular changes

• Atypical squamous or glandular cells of undetermined significance

• Cells in the premalignant or malignant category

In these cases, LabCorp will charge for the associated service. (Slides that are routinely reviewed by a pathologist for quality control purposes are not included.)

References

Hutchinson ML, Cassin CM, Ball HG 3rd. The efficacy of an automated preparation device for cervical cytology. Am J Clin Pathol. 1991 Sep; 96(3):300-305.1877527
Hutchinson ML, Isenstein LM, Goodman A, et al. Homogeneous sampling accounts for the increased diagnostic accuracy using the ThinPrep® processor. Am J Clin Pathol. 1994 Feb; 101(2):215-219.8116578
Joseph MG, Cragg F, Wright VC, et al. Cytohistological correlates in a colposcopic clinic: A 1-year prospective study. Diagn Cytopathol. 1991; 7(5):477-481.1954825
Wilbur DC, Cibas ES, Merritt S, James LP, Berger BM, Bonfiglio TA. ThinPrep® Processor: Clinical trials demonstrate an increased detection rate of abnormal cervical cytologic specimens. Am J Clin Pathol. 1994 Feb; 101(2):209-214.8116577

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
193000 Pap IG (Image Guided) 191121 Test ordered: N/A
193000 Pap IG (Image Guided) 191158 ****************************** N/A
193000 Pap IG (Image Guided) 191108 DIAGNOSIS: 22637-3
193000 Pap IG (Image Guided) 191166 Interpretation N/A
193000 Pap IG (Image Guided) 191170 Category: N/A
193000 Pap IG (Image Guided) 191173 Recommendation: N/A
193000 Pap IG (Image Guided) 191169 Infection: N/A
193000 Pap IG (Image Guided) 191172 Adequacy: N/A
193000 Pap IG (Image Guided) 191111 Recommendation: 19773-1
193000 Pap IG (Image Guided) 191109 Specimen adequacy: 19764-0
193000 Pap IG (Image Guided) 191159 ****************************** N/A
193000 Pap IG (Image Guided) 191154 Source: 19763-2
193000 Pap IG (Image Guided) 191160 Clinician provided ICD9: 52797-8
193000 Pap IG (Image Guided) 191174 Clinician provided ICD10: 52797-8
193000 Pap IG (Image Guided) 191107 Clinical history: 22636-5
193000 Pap IG (Image Guided) 191124 Amended report: N/A
193000 Pap IG (Image Guided) 191110 Additional comment: 22638-1
193000 Pap IG (Image Guided) 191125 Addendum: 22639-9
193000 Pap IG (Image Guided) 191123 Maturation index: N/A
193000 Pap IG (Image Guided) 191112 Performed by: 19767-3
193000 Pap IG (Image Guided) 191128 QC reviewed by: N/A
193000 Pap IG (Image Guided) 191145 Diagnosis provided by: N/A
193000 Pap IG (Image Guided) 191113 Electronically signed by: 19769-9
193000 Pap IG (Image Guided) 191139 Special procedure: N/A
193000 Pap IG (Image Guided) 191129 Cytology history: N/A
193000 Pap IG (Image Guided) 191179 Previous history: N/A
193000 Pap IG (Image Guided) 191144 QA comment: N/A
193000 Pap IG (Image Guided) 019018 . 11546-9
193000 Pap IG (Image Guided) 191157 Pathologist provided ICD9: 52797-8
193000 Pap IG (Image Guided) 191175 Pathologist provided ICD10: 52797-8
193000 Pap IG (Image Guided) 190120 . N/A
193000 Pap IG (Image Guided) 190109 Note: N/A
193000 Pap IG (Image Guided) 000000 Test Methodology: 47527-7
193000 Pap IG (Image Guided) 191167 Photomicrograph N/A
193000 Pap IG (Image Guided) 019030 . N/A
193000 Pap IG (Image Guided) 019031 Patient Counseling Report N/A
Reflex Table for Test Methodology:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 192555 Change IG Pap to LB Pap 000000 LBP CPT Code Automation 47527-7
Reflex Table for Test Methodology:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 192555 Change IG Pap to LB Pap 000000 LBP CPT Code Automation 47527-7

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The LOINC® codes are copyright © 1994-2017, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee. Permission is granted in perpetuity, without payment of license fees or royalties, to use, copy, or distribute the LOINC® codes for any commercial or non-commercial purpose, subject to the terms under the license agreement found at https://loinc.org/license/. Additional information regarding LOINC® codes can be found at LOINC.org, including the LOINC Manual, which can be downloaded at LOINC.org/downloads/files/LOINCManual.pdf