Pathology/Lab Coding Alert

Follow the continuing MAAA payment debate, too.

Microbiology, immunohistochemistry, molecular pathology — here’s a sneak peak at some of these lab procedures that will feature new CPT^® codes beginning Jan. 1, 2014. Get familiar with the new codes and possible pricing parameters to make sure your lab is ready when the new year rolls around.

CMS invited payment recommendations for more than 15 new codes at the annual Clinical Laboratory Fee Schedule (CLFS) public meeting held July 10, according to conference coordinator Glenn McGuirk. The agency will determine the basis of payment and post the recommendations as soon as possible, McGuirk said.

Basis of payment glossary: CMS will determine payment for new codes by one of two methods:

Crosswalk: This involves setting the payment rate equivalent to that of an existing code that uses similar test methodology

Gapfill: This process allows individual Medicare contractors to establish carrier-specific payment amounts, from which CMS will finalize payment recommendations.

Look Ahead With This Summary Table

We’ve prepared a preliminary glance at what to expect for next year based on information from the CLFS public meeting and AMA editorial panel comments:

* Until the annual publication of the CPT^® code set, small further revisions may occur

+ Recommended by some participants commenting on particular code at the public meeting

^ Multianalyte assays with algorithmic analyses

Therapeutic drug assays: You’ll find 10 new codes for therapeutic drug assays in CPT^® 2014. Most speakers at the CLFS public meeting recommended crosswalking these codes as a basis of payment, but commentators were split about which codes to use for the crosswalk.

Most commentators urged CMS to use two methodology codes for the payment basis, as follows, depending on the new code test method:

• 82491 — Chromatography, quantitative, column (e.g., gas liquid or HPLC); single analyte not elsewhere specified, single stationary and mobile phase
• 82542 — Column chromatography/mass spectrometry (e.g., GC/MS, or HPLC/MS), analyte not elsewhere specified; quantitative, single stationary and mobile phase.

Others presenters suggested crosswalk payments to existing codes in the CPT^® therapeutic drug assay section. For instance, specific crosswalks are recommended for the 10 new codes “based on existing drug codes that have similar analytical methods and clinical uses,” said Greg Root, speaking on behalf of the American Association for Clinical Chemistry.

Reconsider MAAA Payment Scheme

CMS took comments at the July 10 CLFS public meeting to reconsider multianalyte assays with algorithmic analyses (MAAA) pricing for CY 2014. Codes for reconsideration include 81500-81512 and the three MAAA administrative codes 0001M-0003M.

Back story: MAAAs are “procedures that utilize multiple results derived from assays of various types … as well as other patient information (if used)” to perform algorithmic analysis and report findings as a numeric score or probability, according to CPT^® instruction.

CMS determined last year not to recognize the new MAAA codes for CY 2013 payment. Instead, the agency instructed labs to bill the “underlying clinical laboratory tests on which the MAAA is done.”

The need to accept and properly price the MAAA codes was a common theme at the CLFS public meeting. “CMS should move forward … to recognize MAAAs as a class and set payment rates for at least some of the tests …” urged Eric Zimmerman, speaking on behalf of Coalition for 21^st Century Medicine.

Many presenters recommended gapfill methodology for the MAAA basis of payment, which would allow CMS to gather pricing data from individual Medicare contractors before establishing a fee schedule amount. On the other hand, a few presenters endorsed crosswalking each MAAA code to the underlying lab test codes. 

Look for CMS to post the CY 2014 payment recommendations by September 2013 at  www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/Laboratory_Public_Meetings.html