Pathology/Lab Coding Alert

But RVU changes still in effect.

Pathologists, along with all practitioners paid on the Medicare Physician Fee Schedule (PFS), can breathe a sigh of relief. Congress voted to halt the 26.5 percent rate cut for 2013 that was tied to the sustainable grown rate (SGR) formula. 

The action freezes Medicare payment rates at the 2012 level through Dec. 31, 2013. The bill also defers the automatic 2 percent across-the-board sequestration cuts for two months. Congress fixed the new 2013 conversion factor at $34.0230.

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Although medical associations were relieved about the continuing Medicare payments for 2013, they lamented the fact that the government had not permanently fixed the problem by overhauling the sustainable growth rate (SGR) formula. 

“This patch temporarily alleviates the problem, but Congress’ work is not complete,” said AMA president Jeremy Lazarus in a statement. “It has simply delayed this massive, unsustainable cut for one year. Over the next months, it must act to eliminate this ongoing problem once and for all.”

“The conversion rate from 2012 will now apply to the 2013 CPT Relative values for each code,” explains Barbara J. Cobuzzi, MBA, CPC, CENTC, CPCH, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J. “Please check your Medicare MAC’s website and make sure it has been updated to reflect this change as of the January 1st congressional vote. Your encoder, such as Codify, will be reflecting this continuation of the 2012 conversion factor.”

“Note that the fees from 2012 will not necessarily be the same in 2013, because the RVUs for many CPT codes have changed,” Cobuzzi explains. 

For instance: You’ll see a 33.4 percent pay reduction for 88305 (Level IV - Surgical pathology, gross and microscopic examination) (global fee, non-facility) based on RVU changes. The 88305-TC payment reflects a 51.7 percent pay cut.