Pathology News
HARVARD PILGRIM (HPHC) Publishes Molecular Code Fees
5/16/2013 – Effective May 1, 2013, HPHC updated its fee schedule for the new molecular codes (81200-81479) based on the rates published by Massachusetts’ Â local Medicare carrier, NHIC. Providers may request a sample fee schedule by calling HPHC’s Provider Services at (800) 708-4414.Tags: Medical Billing, Pathology Billing, Pathology Coding
MA – BCBSMA – New Instructions for Monitoring Molecular and Genetic Tests
5/16/2013 – In the fall of 2013, BCBSMA will ask ordering clinicians and testing laboratories to use McKesson’s online Clear Coverage application to supply them with data for genetic tests and molecular diagnostic services. BCBSMA states the data will provide information on which tests are being ordered and why and will help reduce the [...]Tags: Laboratory billing, Medical Billing, Pathology Billing
AETNA Lowers Lab Fee Schedule
5/16/2013 – Effective July 1, 2013, Aetna will lower their reimbursement rates for lab services for all health plans to equal only 45% to 50% of the national Medicare reimbursement rates, according to an article in the April 2013 edition of Laboratory Economics. Â Aetna states that it calculated its new rates based on “industry [...]Tags: Medical Billing, Pathology Billing. Pathology Coding
Pathologists May Earn Additional 0.5% in Medicare MOCP Initiative
 May 1, 2013 – Pathologists may earn another 0.5% of their allowed Medicare charges in addition to the 0.5% earned through the PQRS incentive program by participating in the Maintenance of Certification Program (MOCP).  The MOCP is a continuous assessment program that advances quality and the lifelong learning and self-assessment of board certified [...]Tags: PQRS Incentive Program
COVENTRY/HEALTH AMERICA: Human Chorionic Gonadotropin
April 12, 2013 – According to CMS policy, human chorionic gonadotropin (84702) is payable when billed with specific diagnoses. Coventry Health will follow CMS’ guidelines and will deny claims billed with code 84702 in the absence of one of the designated covered diagnoses identified in the NCD coding manual. Based on CMS IOM 100.03, [...]Tags: Coding, Medical Billing, Pathology Billing, Pathology Coding
PA – HIGHMARK BCBS – Adjusts Clinical Laboratory Fee Schedules
3/22/2013 Effective as of service dates of March 4, 2013, Highmark adjusted its professional clinical laboratory fee schedule, which is based on the 2013 Medicare Clinical Diagnostic Laboratory Fee Schedule. Â This change will impact clinical laboratory allowances for UCR, and the Premier Blue Shield and Keystone Health Plan West fee schedules. The reimbursement for [...]Tags: Medical Billing, Physician Fee Schedules
AETNA – New Pathology Coding Policy
3/22/2012 – Effective 6/1/2013, Aetna will only allow code 87621 (Infections agent detection by nucleic acid (DNA or RNA); papillomavirus, human, amplified probe technique) to be billed three times per service date.Tags: Medical Billing, Pathology Billing, Pathology Billing. Pathology Coding
MA – MASS HEALTH – Drug Test/Screen Policy Update
2/15/2013 – As of service date, January 1, 2013, Mass Health established new claim edits for quantitative drug tests billed on the same date of service as a drug screen service. Â Denial 8304 (lab conflict w/each other on same day) will be the denial code shown on the EOB when quantitative drug tests are [...]Tags: Medical Billing, Pathology Billing, Pathology Coding
MA – MASS HEALTH – Drug Screen Policy Update
2/15/2013 – Mass Health has established new claim edits for quantitative drug tests billed on the same date of service as a drug screen service, effective January 1, 2013. Some of the changes are: Confirmatory drug tests should be billed with procedure code 80102 – (drug confirmation, each procedure) Non-payment for drug screen tests [...]Tags: Medical Billing, Pathology Billing, Pathology Coding
MA – HARVARD PILGRIM – Molecular Pathology Codes Billing & Payment Policy
01/23/2013 – HPHC is processing the new CPT codes (81200-81479)Â for Molecular Pathology . Â HPHC has also established a pricing policy for these codes and has updated their standard fee schedules. Â Since these are very new codes, HPHC will review benchmark pricing information and may make additional fee schedule updates later in 2013. Providers may [...]Tags: Coding, Medical Billing, Pathology Billing, Pathology Coding
Pathology and Independent Labs: Fee Changes in 2013
12/31/2012 – In the 2013 Medicare Physician Fee Schedule (MPFS),CMS took the hatchet to pathology fees as they revalued the technical component (TC) of several important pathology codes. In addition, they reduced fees by 1% to cover the cost of the primary care fee increase, and applied another 1% reduction as part of the [...]Tags: 2013 Medicare Physician Fee Schedule, Pathology Billing, Pathology Coding, SGR and Medicare Fee Schedule
Molecular Pathology Codes: 2013 Reimbursement
December 28, 2012 – In the 2013 Medicare Physician Fee Schedule (MPFS),CMS ruled that the new molecular pathology codes will be paid under the Clinical Laboratory Fee Schedule (CLFS) because these services do not ordinarily require interpretation by a physician to produce a meaningful result. Most of the laboratory processes involved in performing these [...]Tags: Medical Billing, Pathology Billing, Pathology Coding
PATHOLOGY UPDATE: 88363 Billing for Retrieval of Archived Surgical Pathology Cases
December 28, 2012 88363 Examination and selection of retrieved archival (i.e., previously diagnosed) tissue(s) for molecular analysis (e.g., KRAS mutational analysis). In 2011, CPT code 88363 was created to capture a pathologist’s findings following the identification and selection of appropriate tumor tissue from a previously diagnosed surgical pathology case. This article is a reminder that [...]Tags: Medical Billing, Pathology Billing, Pathology Coding
New BCBS Guidelines Change Lab Billing
December 28, 2012 – This past year all Blue Cross Blue Shield (BCBS) programs made changes to their Blue Card plans that affect how independent clinical laboratories must bill to be paid for their claims. The Blue Card plan is a national program offered through the BCBS Association that enables members of one Blue [...]Tags: Laboratory billing, Pathology Billing, Provider Contracting, Provider Enrollment
A Quick Review of Cytopathology of Fine Needle Aspiration (Biopsy) (FNA)
Summer 2012 – Clear and precise documentation of procedures and services performed assists our coders in determining the correct CPT code for billing. One of the issues we find in pathology is the lack of documentation to determine whether we are able to bill code 88177 for an FNA performed on the same site [...]Tags: Medical Billing, Pathology Billing, Pathology Billing. Pathology Coding
Stage 2 EHR Meaningful Use (MU) for Pathology
Summer 2012 – There are several provisions in the final Stage 2 EHR meaningful use (MU) ruling that address items of interest to pathologists. Â One is an exemption that pathologists may use if they will not be ready to attest to MU in time to avoid the 2015 penalties. Â Other provisions may provide benefits [...]Tags: EHR Incentive Program, Meaningful Use, Medical Billing, Pathology Billing
Pathology PQRS Update
Summer 2012 – The proposed 2013 Medicare Physician Fee Schedule, which was released in August, did not include any new PQRS measures for pathologists. Pathologists will continue to report the established 5 PQRS measures in 2013. REMINDER:Â Please document your services clearly for the measures you are or will be reporting, so AHS coders [...]Tags: Pathology Billing, Pathology Coding, PQRS Incentive Program
11 Year Moratorium of Medicare Payment for the TC of Physician Pathology Services to Hospital Patients Ends June 30, 2012
Spring 2012 – In the final 2000 Physician Fee Schedule (PFS) regulation published on November 2, 1999, CMS implemented a policy to pay only a covered hospital[1] for the technical component (TC) of physician pathology services for fee-for service Medicare beneficiaries who are inpatients or outpatients of a covered hospital.  CMS stated that payment for [...]Tags: Laboratory billing, Medical Billing, Pathology Billing
Patient Access to Laboratory Tests
Spring 2012 – In our world of instant access to information, access by patients to their medical records and test results have been granted through HIPAA and the EHR regulations. However, there are those who want to be cautious in deciding what records and under what conditions patients’ health records should be released to [...]Tags: Medical Billing, Pathology Billing
PAtHOLOGY ICD-10-CM CODING – What You Need to Know
3/31/2012 – CMS has announced a potential delay in ICD-10 implementation beyond October 1, 2013. But if you have not yet begun planning for this change, you are already behind schedule! Every specialty will be affected by the transition from ICD-9 to ICD-10. The wide range of diagnoses that cause referring physicians to order laboratory [...]Tags: ICD-10, Medical Billing, Pathology Billing, Pathology Coding
2012 Clinical Laboratory Fee Schedule
3/31/201 – Although pathologists and clinical laboratories appreciated Congress’ efforts to block the 27.4% cut in the Medicare reimbursement rate for 2012, they were not happy about the additional price tag put on the clinical laboratory fee schedule to help pay for it. In February, Congress passed and the President signed the Middle Class Tax [...]Tags: Medical Billing, Pathology Billing, Pathology Coding, SGR and Medicare Fee Schedule
Coding Special Stains
3/31/2012 – The CMS NCCI (National Correct Coding Initiative) Policy Manual has introduced new special stains policies that will impact coding and reimbursement for pathologists and laboratories. The descriptions of these changes are from the NCCI Policy Manual, effective January 1, 2012. Special Stains The unit of service of special stains codes 88312-88313 is each [...]Tags: Medical Billing, Pathology Billing, Pathology Coding
AETNA – Lab Panel Policy for 2013
December 28, 2012 – Effective March 1, 2013, Aetna will change how they bundle lab codes into the more comprehensive panel code when a designated number of component codes are billed. For more information, refer to their Claims, Policy Information (Step 3), Claim Payment and Coding Policies, Laboratory Panels on Aetna’s provider website.Tags: Medical Billing, Pathology Billing, Pathology Coding
Connecticut Medicaid – Molecular Pathology Codes
December 28, 2012 – The Department of Social Services (DSS) will add the new molecular pathology codes in the 81201-81479 range for reimbursement, but all will require prior authorization. (PA) Â PA must be requested prior to the date of service and services will not be authorized retroactively. Due to the delay in receipt of [...]Tags: Medical Billing, Pathology Billing
PA – HIGHMARK BCBS – Authorization Needed for Gene Analyses
10/24/2012 – Effective Oct. 15, 2012, Highmark revised its list of outpatient procedures/services requiring authorization. The following procedure codes were added to the authorization list. 81280 –  Long QT Syndrome Gene Analyses  (E.G., KCNQ1, KCNH2, SCN5A, KCNE1, KCNE2, KCNJ2, CACNA1C,CAV3, SCN4B, AKAP, SNTA1, AND ANK2); Full Sequence Analysis 81281 –  Long QT Syndrome Gene [...]Tags: Coding, Medical Billing, Pathology Billing. Pathology Coding
NY – Empire BCBS – Drug Screening Codes – Billing Update
10/24/2012 –  Effective January 1, 2013, Empire will no longer reimburse qualitative drug screening codes 80100, 80101, and 80104. Qualitative drug screening will only be eligible for reimbursement under codes G0431 and G0434. Both codes G0431 and G0434 will be eligible for 1 unit of reimbursement per date of service. Use of code G0431 (direct [...]Tags: Coding, Medical Billing, Pathology Billing, Pathology Coding
United Healthcare – Patients May Access & Share Personal Health Records
September 24, 2012 – UnitedHealthcare has made it possible for patients to view, print, and save their UnitedHealthcare Personal Health Record (PHR) by clicking on the Blue Button Download My Data® located on their consumer portal called myuhc.com. Members will now be able to share their PHR with their physicians, giving a more comprehensive picture [...]Tags: billing, Compliance, EHR, Healthcare Reform, Medical Billing
ICD-10 Final Rule Issued
September 5, 2012 – On August 24, 2012, HHS issued the final rule concerning the transition from ICD-9-CM  to ICD-10-CM diagnosis coding. As suggested in the proposed ruling in April 2012, HHS has finalized the year delay for the transition to ICD-10 coding from October 1, 2013 to October 1, 2014. Other options suggested by [...]Tags: Anesthesia Billing, ASC Billing, CMS Updates, Healthcare Reform, ICD-10, Medical Billing, Radiology Billing, Surgery Billing
EHR Stage 2 Final Rule Released
September 5, 2012 – On August 23, 2012, CMS announced the final rule for Stage 2 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. The rule specifies the Stage 2 criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to successfully participate in the EHR [...]Tags: Anesthesia Billing, ASC Billing, CMS Updates, EHR, Healthcare Reform, Meaningful Use, Medical Billing, Pathology Billing, Radiology Billing, Surgery Billing
EHR Stage 2 Ruling – Possible Exemptions for Anesthesiologists, Pathologists and Radiologists
September 5, 2012 – CMS has designated the specialties of anesthesiology, radiology and pathology as qualifiers for a new Scope of Practice exemption granted in the EHR Stage 2 ruling announced on August 23, 2012. Â This exemption is aimed at eligible professionals (EPs) who: lack both face-to-face interactions with patients, and lack the need [...]Tags: Anesthesia Billing, ASC Billing, CMS Updates, EHR, Healthcare Reform, Meaningful Use, Medical Billing, Pathology Billing, Radiology Billing
CT MEDICAID – Prior Authorization for Molecular Codes
July 25, 2012 – The Department of Social Services is requiring a prior authorization (PA) for the billing of the new molecular codes that were added to the CPT Code set effectiveJanuary 1, 2012. (CPT’s 81200 – 81408) When there is a new code for the molecular pathology test being ordered, providers must request PAs [...]Tags: billing, Coding, Medical Billing, Pathology Billing, Pathology Coding
UNITED HEALTHCARE – Billing Molecular Codes
July 25, 2012 – United Healthcare follows Medicare guidance on reporting Molecular and Pathology CPT Codes. Claims for services that are covered by the new molecular CPT codes should be submitted with both the “stacking codes” and the new molecular codes. The stacking codes will be processed for payment, while the new codes will be considered [...]Tags: billing, Coding, Medical Billing, Pathology Billing, Pathology Coding
HIGHMARK BCBS (PA) – Update on Molecular Pathology Test Codes
May 17, 2012 – Effective April 1, 2012,  Highmark issued specific guidelines for non-facility providers to follow when billing molecular pathology test codes for Highmark Commercial and Medicare Advantage members. For commercial members, providers should report the appropriate molecular pathology procedures test codes that are valid for the service dates beginning on or after January 1, [...]Tags: Coding, Medical Billing
