Pathology/Lab Coding Alert

Take advantage of reportable measures for breast and colon cancer The Physician Quality Reporting Initiative (PQRI) has been the buzz in the physician community -- and should be for pathologists this year, too. Why? Because you have a shot at a 1.5 percent bonus on all of your Medicare services for 2008. Although no quality measures applied to pathology in 2007, CMS implemented two performance standards that pathologists can report in 2008. "Even if you sit out the voluntary program this year, you need to get up to speed for a potentially expanding list of quality measures that could impact your bottom line in years to come," says Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc., in Simpsonville, Ky., and publisher of Pathology Service Coding Handbook. Get a Breakdown of the Newest Measures You likely already comply with the following 2008 PQRI quality measures for pathologists: - Measure 99: Breast Cancer Patients Who Have a pT and pN Category and Histologic Grade for Their Cancer
Description: Percentage of breast cancer resection pathology reports that include the pT category (primary tumor), the pN category (regional lymph nodes) and the histologic grade - Measure 100: Colorectal Cancer Patients Who Have a pT and pN Category and Histologic Grade for Their Cancer
Description: Percentage of colon and rectum cancer resection pathology reports that include the pT category (primary tumor), the pN category (regional lymph nodes) and the histologic grade. Do this: Report compliance with both measures using new CPT Category II code 3260F (pT category [primary tumor], pN category [regional lymph nodes], and histologic grade documented in pathology report). Overcome omission: Although CPT 2008 includes an appendix of Category II codes and a supplemental Appendix H that serves as a crosswalk to reporting instructions for each measure, 3260F did not make it into the print edition. You can access updated information at http://www.ama-assn.org/go/cpt. Always Use the Appropriate ICD-9 and CPT Codes Pathologists don't need to notify Medicare to start participating in the PQRI. Just report quality code 3260F on eligible claims submitted to your Medicare contractor. That's not all: "Medicare will only recognize and count the PQRI code when you bill it on the same claim with an eligible CPT code and a qualifying ICD-9 code," says Joyce Matola, billing manager for the Center for Cancer and Hematologic Disease in Cherry Hill, N.J. "Medicare carriers will deny claims that have just the 3260F code on them," Padget says. "Furthermore, you can't amend or correct a paid claim to add the 3260F code; it has to be there the first time you file." Caution: "Not all colorectal and breast cancer cases qualify for PQRI," Padget says. Report [...]