Pathology/Lab Coding Alert

Expect more for pathology consultation.

Depending on which codes represent high-volume procedures in your lab, 2015 could be a payment boon — or a bust. That’s true even if the Physician Fee Schedule (PFS) conversion factor holds steady, (see, “Beware Potential ‘Ides of March’ Pay Cut,” on page 11 of this issue).

Here’s why: You might experience more or less pay for services your pathologist performs this year, compared to 2014, based on PFS relative value unit (RVU) changes.

Read on for a sampling of common pathology procedures that show the largest RVU changes, resulting in some of the biggest payment gains and losses this year.

Benefit from Surgical/Cytopathology Upgrades

Expect an across-the-board 2015 pay raise for surgical pathology codes 88300-88309 (Surgical pathology … examination …), ranging from 3 to 7 percent increases in reimbursement for the global service.

Caveat: Most of the surgical pathology RVU increase involves the technical component, so if you’re billing with modifier 26 (Professional component), don’t expect as much additional pay.

Although less dramatic, you’ll also see about a 3 percent pay increase for ancillary surgical pathology procedures such as some special stains (88312, 88313, Special stain including interpretation and report …).

Cytopathology bonus: Global codes 88104-88112 (Cytopathology …) show a payment increase between 1 and 8 percent for 2015.

“As with the surgical pathology codes, most of the RVU increase for ancillary and cytopathology services is in the technical component,” says R.M. Stainton Jr., MD, president of Doctors’ Anatomic Pathology Services in Jonesboro, Ark.

Capture Consultation Increases

Pathologists can expect more than a 4 percent pay increase for most global-service intraoperative consultations (88331-88334, Pathology consultation during surgery …), with much of the RVU increase stemming from the technical service. For instance, billing 88333 TC (Technical component) pays $44.34 in 2015, compared to $40.84 in 2014 — a 9 percent pay increase.

Outside lab consultation codes 88321-88323(Consultation and report on referred [slides or material]…) also show a pay increase in 2015, ranging from 1 to 3 percent for the global service.

Biggest winner: Among services your pathologist might commonly perform, your largest percentage pay increase might be the 10 percent for 80500 (Clinical pathology consultation; limited, without review of patient’s history and medical records). You’ll also see a 7 percent increase for related code 80502 (…comprehensive, for a complex diagnostic problem, with review of patient’s history and medical records). Remember that you can report these codes only if a referring physician requests the consultation for a clinical lab test with an abnormal result, and the pathologist renders a medical opinion and report on the findings.

Biggest loser: If your pathologist performs electron microscopy, expect a huge pay cut for the global service (88348, Electron microscopy; diagnostic) — a 51.0 percent reduction from $702.49 to $346.82 (conversion factor 35.7547 for Jan. 1 through March 31) for the non-facility charge. The downgrade involves the technical component — professional component billing with modifier 26 actually increases pay by 2 percent for this code.

Watch for IHC, ISH Pay Impact

CPT® 2015 implemented big changes to codes for immunohistochemistry (IHC) and in situ hybridization (ISH). Those changes, coupled with RVU determinations for new codes and revisions for existing codes, can have a big impact on your pay for those services.

You can review the code changes, what they mean, and how to use the new and revised codes in Pathology/Lab Coding Alert Vol. 15, No. 11, “Revamp Your IHC and ISH Reporting With 2015 ‘Makeover.” Look to future issues of Pathology/Lab Coding Alert for a full analysis of how these changes might impact your IHC and ISH pay.