Pathology/Lab Coding Alert

 Learn how CMS bombshell could imperil your bonus pay

If you-re a pathologist employed by or contracted with an independent lab, you-re eligible for the Physician Quality Reporting Initiative (PQRI) bonus -quot; right?
 Wrong. According to a recent answer posted on CMS- PQRI FAQ Web site, you won't get a shot at the 1.5 percent bonus on all your Medicare services for 2008, even if you-ve been reporting the eligible pathology measures.
 Although reports have circulated of carriers informing independent-lab pathologists that they can participate in PQRI, the CMS posting makes it official that they can-t, according to Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc., in Simpsonville, Ky., and publisher of Pathology Service Coding Handbook.

Read It and Weep

 Here's the FAQ that CMS posted online at http://questions.cms.hhs.gov/ on March 26:
 -Question: I am a pathologist employed by an independent laboratory and have been informed by the Medicare carrier that I cannot participate in PQRI for place of service 81. Is this correct?-

 -Answer: Yes. Independent laboratories (ILs) are a supplier specialty (69), not a physician specialty. The rendering provider field (24J) on the CMS-1500 claim is not valid for IL claims in the billing methodology for ILs. Because the statute authorizing PQRI requires analysis of reporting and allowed charges at the level of the individual professional, pathology services billed under IL rules are not able to be considered in PQRI analyses.-
 -Unfortunately, the posting still begs the question whether POS 81 is the -offensive- factor, or the specialty 69 classification,- Padget says. -This seems to be a major -oops- event.-
 Apparently the problem is that IL claims don't go through the same processing system as -regular- physician claims, even though ILs certainly bill for services paid from the Medicare physician fee schedule, at times.
 -Nothing in the PQRI enabling legislation indicates that Congress intended to exclude these pathologists from participating, but that's what it's come down to,- Padget says. -CMS officials currently indicate they have no intention of fixing this problem any time soon, so we-ll just have to see how this all plays out.-