Pathology/Lab Coding Alert

CMS proposes to eliminate 83036 and 83037 pay After upping the ante on the 2007 fee schedule for 83037, Medicare has proposed a 2008 G code that may take it all away. Let our experts keep you up to date on the changes so you can keep your claims clean. Code Change Could Compromise Your Pay At its public meeting for new lab-code pricing held July 16, CMS proposed creating a new HCPCS Level II G code (Gxxxx, Hemoglobin; glycosylated [A1C]) to replace currently used codes 83036 (Hemoglobin; glycosylated [A1C]) and 83037 (Hemoglobin; glycosylated [A1C] by device cleared by FDA for home use). Depending on CMS- final 2008 pricing for the G code, labs could stand to lose $7.50 for each FDA-approved home-use test -- that's the difference between current fee schedule rates for 83037 ($21.06) and 83036 ($13.56). -We don't really understand why CMS is proposing a G code for A1C testing after so much effort went into establishing differential pricing for 83037, which is only a 2-year-old code,- says Katharine Ayres, MT (ASCP), CT, director of legislative and regulatory affairs for Clinical Laboratory Management Association (CLMA). Most professional organizations providing comments at the public meeting, such as CLMA, the College of American Pathologists (CAP), the American Society for Clinical Pathology (ASCP), and the American Clinical Laboratory Association (ACLA), recommended crosswalking Gxxxx to 83036 if CMS insists on implementing the new code. Avoid Lab Method Distinction For Medicare beneficiaries, the new G code would no longer allow labs to distinguish between work described by 83036 -- a standard A1C lab test, usually determined by ion-exchange affinity chromatography, immunoassay or agar gel electrophoresis -- and work described by 83037 -- an A1C test using a device cleared for home use by the Food and Drug Administration. Don't miss: The type of test, not the place of service, distinguishes 83036 from 83037. Whether the testing takes place at a hospital or an independent lab or a physician office, you should report 83037 for a self-contained A1C device that the FDA has approved for home use, such as Bio-Rad Micromat II Hemoglobin A1C, Cholestech GDX A1C Test, Metrika A1C, or Provalis Diagnostics Glycosal HbA1c Test. Despite the home-use terminology, Medicare won't cover patient self-testing for A1C. Medicare will only cover the test from providers or laboratories certified under the Clinical Laboratory Improvement Amendments (CLIA) with at least a certificate of waiver. You should refer to the waived test list to make sure CLIA approves your particular test kit for this code, and you should append modifier QW (CLIA waived test) to 83037. Watch for: Expect updates to the CLIA-waived test list and to Medicare coverage policy statements concerning the new G code. [...]