Pathology/Lab Coding Alert

Medicare fee schedule raises 88184-88185 payment by at least 22 percent

After cutting flow-cytometry payment nearly in half in 2005, you might recoup some lost ground if Medicare approves the proposed Physician Fee Schedule. The payment gains would be for the technical component of flow cytometry, not the professional fees.

Payment jump: The proposal, published in the Aug. 8 Federal Register, would increase payment for 88184 (Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker) by 22 percent, and for +88185 (… each additional marker [list separately in addition to code for first marker]) by 33 percent.

2005 Codes and Fees Slashed Payment

CPT Codes 2005 deleted flow cytometry code 88180, which had described both the technical and professional interpretation service on a “per marker” basis. In its place, CPT 2005 added new codes for the flow cytometry technical component--88184 for the first marker and 88185 for each additional marker--says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore. Codes 88187-88189 (Flow cytometry, interpretation ...) represent the professional service for flow cytometry panels and pay for 2-8 markers, 9-15 markers, or 16 or more markers, respectively.

The 2005 payment methodology meant a physician who interpreted 15 markers would see a 71 percent cut in payment in 2005 from the 2004 rate of $296, said Jason DuBois, the American Clinical Laboratory Association’s vice president for government, during Medicare’s open- door forum on the 2005 Physician Fee Schedule.
 
Although the professional fee will decline slightly in 2006 based on the proposal, the technical fee for a 15-marker panel should increase to $529.05, assuming the same conversion factor as last year. The technical charge had decreased from $722.47 in 2004 to $400.95 in 2005.