Pathology/Lab Coding Alert

Good news for pathologists: You wont have to cough up overpayments arising from the delayed implementation of the 2003 Medicare Physician Fee Schedule. July had promised to be a tricky cash-flow month because CMS had planned to require carriers to collect claims overpayments for certain services provided in January and February of this year.
 
The problem arose from the delay in the effective date of the Fee Schedule which was March 1, 2003, rather than Jan. 1. Claims with dates of service in January or February were supposed to be paid at 2002 rates. But due to claims processing limitations, if you submitted those claims after March 1, they were paid at the 2003 rates, which were higher for many pathology services, says Laurie Castillo, MA, CPC, CPC-H, CCS-P, president of Professional Coding and Compliance Consulting in Manassas, Va.
 
CMS had planned to go after those so-called overpayments in a mass adjustment in July and has been warning doctors about the move for months. But much to the relief of pathologists, the agency has had an 11th-hour change of heart.
 
If an overpayment exists, you will not be receiving any Demand letters related to an incorrect payment based on the delay of the 2003 MPFS, CMS tells physicians. This also means that Medicare beneficiaries will not be receiving copies of those Demand letters that would have potentially caused unnecessary confusion to them. To see CMS notice on the mass adjustments, go to the Web site http://cms.hhs.gov/physicians/goodnews.pdf.

Avoid Overpayment Adjustment and Save Cash

Certain pathology services pay considerably more at the 2003 rate than at the 2002 rate. For example, flow cytometry (88180, Flow cytometry; each cell surface, cytoplasmic or nuclear marker) pays 61 percent more, and a comprehensive consultation (88325, Consultation, comprehensive, with review of records and specimens, with report on referred material) pays 59 percent more in 2003.
 
Avoiding overpayment adjustments could save you revenue, depending on the number and types of procedures involved, says Stacey Hall, RHIT, CPC, CCS-P, director of corporate coding for Medical Management Professionals Inc., a national billing and management firm in Chattanooga, Tenn. But perhaps the biggest savings will be in customer relations not having to deal with confusing demand letters sent to patients.

Ask for Underpayments Back

 Even so, Medicare pays less for some pathology services, such as special stains (+88313, Special stains [list separately in addition to code for surgical pathology examination]; Group II, all other [e.g., iron, trichrome], except immunocytochemistry and immunoperoxidase stains, each) in 2003 than 2002 so what about underpayments?
 
CMS added an important caveat to its mass adjustment notice: You should be aware that if you bring to the attention of the Medicare carrier that an incorrect payment for January or February 2003 was received, the carrier will still process such an adjustment.
 
That means you can request a correction of underpayments on January and February claims filed after March 1, Hall says.