CPT Code Review for Routine Gynecological Screening
Most of your CPT codes are correct, but CPT 86632 (Chlamydia IgM antibody) is incorrect and should be replaced with a nucleic acid amplification test (NAAT) code for Chlamydia, such as CPT 87491 or 87492.
Correct CPT Codes
Pap Smear and HPV Testing
- CPT 88175 (liquid-based cytology, thin-layer preparation) is the appropriate code for the Pap smear component 1
- CPT 87624 (HPV DNA detection, high-risk types) is correct for high-risk HPV testing, which is recommended for women aged 30-65 years as part of co-testing with Pap smears every 5 years 2, 3
STI Screening Codes
- CPT 87590 (Neisseria gonorrhoeae detection by nucleic acid, direct probe) is appropriate for gonorrhea screening 2
- CPT 87661 (Trichomonas vaginalis amplified probe technique) is correct for trichomoniasis screening 2
The Critical Error: Chlamydia Testing
CPT 86632 (Chlamydia IgM antibody) is NOT appropriate for routine screening. This code represents serologic antibody testing, which is not recommended for Chlamydia screening 2.
Correct Chlamydia Codes
You should use nucleic acid amplification testing (NAAT) instead, which is the gold standard for Chlamydia screening:
- CPT 87491 (Chlamydia trachomatis, amplified probe technique) or
- CPT 87492 (Chlamydia trachomatis, quantification)
The USPSTF recommends screening sexually active women aged 24 years and younger, and older women at increased risk, using nucleic acid amplification tests 2. Research confirms that NAAT methods from cervical specimens have sensitivities of 93-99% and specificities of 95.5-99% 4.
Clinical Context and Appropriateness
Age-Appropriate Screening
The appropriateness of these tests depends on the patient's age:
- Ages 21-29: Pap test alone every 3 years is recommended; HPV testing is NOT recommended for routine screening in this age group 3
- Ages 30-65: Co-testing with Pap + HPV every 5 years is preferred, or Pap alone every 3 years 2, 3
STI Screening Indications
- Gonorrhea and Chlamydia screening is recommended for sexually active women aged 24 years and younger, and for older women at increased risk 2
- Trichomonas screening is not universally recommended for asymptomatic women, but can be performed during routine examination 2
Common Pitfalls to Avoid
Do not use HPV testing as a standalone screening test in women under 30 years 3. The CDC specifically recommends against HPV testing for women aged 21-29 years for routine screening 3.
Avoid serologic testing for Chlamydia when nucleic acid amplification tests are available and clinically indicated 2. Antibody tests like CPT 86632 are not appropriate for screening purposes.
Ensure the patient meets age and risk criteria for each screening test ordered. The USPSTF provides clear B-grade recommendations for Chlamydia and gonorrhea screening in specific populations 2.
Summary of Recommended Changes
Keep these codes:
- CPT 88175 (Pap smear)
- CPT 87624 (HPV high-risk types) - if patient is ≥30 years
- CPT 87590 (Gonorrhea NAAT)
- CPT 87661 (Trichomonas NAAT)
Replace this code:
CPT 86632 (Chlamydia IgM)→ CPT 87491 or 87492 (Chlamydia NAAT)