Pathology/Lab Coding Alert

Answer correctly and capture Medicare bonus pay Last month our experts gave you a Physician Quality Reporting Initiative (PQRI) coding primer. This month we-ll give you a chance to test your knowledge with a series of questions and answers.
Before you begin, you might want to review the basics in -Pay Attention to Pathology PQRI and Get Medicare Bonus Pay,- in Vol. 9, No. 5, of Pathology/Lab Coding Alert. Maneuver Participation Boundaries  Question 1: Does every physician in a pathology practice have to participate in PQRI to get the bonus?  Answer 1: No. Medicare links PQRI to the physician National Provider Identifier (NPI), so each physician acts independently with respect to PQRI, says Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc., in Simpsonville, Ky., and publisher of Pathology Service Coding Handbook. -Participation in the PQRI is voluntary physician-by-physician,- Padget says.
 You don't have to worry that nonparticipating physicians in the same group will count against your 80 percent reporting threshold to qualify for the bonus. -Medicare will count only the allowed charges attributable to the participating physicians in a group when calculating the lump-sum bonus,- Padget says.  Question 2: Can our lab participate in PQRI if we bill only the technical component of anatomic pathology services?  Answer 2: No. -Only physicians and certain non-physician providers may participate in the PQRI,- Padget says.
 If a hospital or independent laboratory bills only the technical component (TC) of PQRI-eligible colon cancer or breast cancer cases, the lab shouldn't report 3260F.
 Instead: The pathologist who bills the professional component (26, Professional component) separate from the hospital or independent laboratory is eligible to participate in PQRI and report 3260F with the following codes:
- 88307 -quot; Level V -quot; Surgical pathology, gross and microscopic examination, breast, excision of lesion, requiring microscopic evaluation of surgical margins or breast, mastectomy -quot; partial/simple
- 88309 -quot; Level VI -quot; Surgical pathology, gross and microscopic examination, breast, mastectomy -quot; with regional lymph nodes or colon, segmental resection for tumor or colon, total resection.  Pitfall: See -Reporting PQRI? Independent-Laboratory Pathologists Beware- below to learn how CMS limits PQRI participation of pathologists whom an independent lab employs or contracts with for professional services.  
Learn the Modifiers  Question 3: Assuming that the pathologist is participating in PQRI, what should you do if the pathologist doesn't perform the specified quality measure on a colon cancer or breast cancer case that qualifies for PQRI?  Answer 3: You should still report the case as you would any other PQRI-qualifying case -quot; just remember to include the appropriate modifier to explain why the physician did not perform the measure, says Sandra Pinckney, CPC, coder at CEMS in Grand Rapids, Mich. Medicare will count these encounters toward your physician's PQRI total, Pinckney [...]