The Papanicolaou (Pap) test category of “low grade squamous intraepithelial lesion, cannot exclude high grade squamous intraepithelial lesion” (LSIL‐H) is not recognized by The Bethesda System but is commonly used. It is essentially an amalgamation of the official LSIL and ASC‐H categories. Since these two categories have similar follow‐up algorithms, the clinical utility of the combined LSIL‐H category is unclear. We have therefore studied follow‐up patterns for these three entities in our laboratory to determine the real‐world impact of each in our patient population. We searched our pathology database over an 18‐month period to find Pap tests (predominantly ThinPrep) interpreted as LSIL‐H (137), LSIL (2,189), and ASC‐H (101). Like other studies, we found that the discovery rate of high grade dysplasia in biopsies after LSIL‐H (31.9%) was similar to ASC‐H (35.3%) and was higher than LSIL (7.6%; P < 0.0001). In women with no previous history of dysplasia, the frequency of biopsy follow‐up after the initial Pap test was significantly higher for LSIL‐H (68.3%) than for LSIL (49.6%; P = 0.0038) and similar to ASC‐H (62.3%). We also found that women with an initial negative biopsy or a biopsy positive for low grade dysplasia were more likely to undergo an additional biopsy if the initial Pap test was LSIL‐H (36.2%) than if it was LSIL (18.2%; P = 0.0023). ASC‐H (26.9%) had an intermediate rate. In our patient population, the use of the terminology LSIL‐H is associated with follow‐up biopsy patterns much more similar to ASC‐H than to LSIL. Diagn. Cytopathol. 2013;41:960–964. © 2013 Wiley Periodicals, Inc.