Pathology/Lab Coding Alert

Carriers should use corrected RVUs for 88385, 88386
 
The final fee schedule could lead you astray--CMS issued an emergency update for 2006 that adds relative value units (RVUs) for new array codes rather than leaving them as carrier-priced. Use the following chart to monitor your payment when your lab performs these services.

Update Adds Technical and Global RVUs

Medicare's final rule, published in the Nov. 21, 2005, Federal Register, lists 0 RVUs and indicates carrier pricing for the global and technical (TC) listings of 88385 (Array-based evaluation of multiple molecular probes; 51 through 250 probes) and 88386 (... 251 through 500 probes). In the Dec. 30, 2005, Change Request 4268, CMS changes the procedure status for these codes to "A" (active) and adds RVUs for each service.
 
Codes May Shortchange Some

Microarrays that contain huge numbers of molecular probes may be under-represented and under-funded by the new codes and new payment schedule. "A comparative genomic hybridization (CGH) study, for example, may include about 2,600 probes and cost a minimum of $1,000 for the test alone," says Diana Voorhees, MA, CLS, MT(ASCP)SH, CLCP, principal with DV & Associates Inc. in Salt Lake City.

"None of the new codes adequately describes the number of probes, and the fee schedule does not sufficiently compensate labs for the cost of the test," she says. 

Add Corrections to Your Fee Schedule

You can use the following chart to update your copy of the Physician Fee Schedule . The modifier 26 (Professional component) values are from the original fee schedule, while the modifier TC and global values are from the change request. Use the current 2006 conversion factor of 36.1770 to calculate the procedure's national payment amount.