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2011Coding and Reimbursement Update

2011Coding and Reimbursement Update. CLMA audioLab November 29, 2010 . Presented by . Diana W. Voorhees, M.A. CLS, MT, SH, CLCP Principal/CEO DV & Associates, Inc. dvassoc@aol.com 801.272.3672. Objectives. Discuss Coding Changes for 2011 including CPT, HCPCS, and ICD-9

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2011Coding and Reimbursement Update

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  1. 2011Coding and Reimbursement Update CLMA audioLab November 29, 2010

  2. Presented by Diana W. Voorhees, M.A. CLS, MT, SH, CLCP Principal/CEO DV & Associates, Inc. dvassoc@aol.com 801.272.3672

  3. Objectives • Discuss Coding Changes for 2011 including CPT, HCPCS, and ICD-9 • Describe latest changes to CCI • Indicate projected reimbursement for 2011 • Discuss pertinent policies and issues affecting laboratory and pathology billing and reimbursement DV & Associates, Inc.

  4. Coding Changes for 2011 • New codes reimbursed under the CLFS and MPFS • Recommendations under CLFS are crosswalk or gapfill • Reconsideration requests for 5 codes • Include deletions and description changes DV & Associates, Inc.

  5. Reconsideration Request • HCPCS G0430 Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure • No comments • Scheduled for deletion DV & Associates, Inc.

  6. Reconsideration Request • HCPCS G0431 Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class • No comments • Providers requesting an examination of payment levels for the two “G” codes • Is it fair to reimburse “kits” the same amount regardless of the number of classes tested? • 80101 not likely to be recognized again by Medicare • Code G0431 apply only to CLIA high complexity laboratories; G0430x5 = $104.15 DV & Associates, Inc.

  7. New Codes for 2011 • CPT 80104 Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure • This code takes the place of G0430 • One organization suggested CPT 80101 ($19.72) and three others suggested G0430 ($20.83) • Apply to CLIA regulated facilities only? DV & Associates, Inc.

  8. New Codes for 2011 • HCPCS GXXX1 Drug screen, other than chromatographic; any number of drug classes, per specimen • No recommendations detected • Use for CLIA waived testing • Xwalk to G0430 and $20.83 DV & Associates, Inc.

  9. New Codes for 2011 • CPT 82930 Gastric acid analysis, includes pH if performed, each specimen • Four organizations recommended CPT 82928 ($9.38) DV & Associates, Inc.

  10. CPT Codes Deleted for 2011 • 82926 Gastric acid, free and total, each specimen • 82928 Gastric acid, free or total, each specimen DV & Associates, Inc.

  11. New Codes for 2011 • CPT 83861 Microfluidic analysis utilizing an integrated collection and analysis device, tear osmolarity • One organization recommended a gapfill, based on the manufacturer’s costing analysis • Xwalk to 83909 and $24 • Sets the scene for coding other procedures using similar devices and thus the outcome can be significant • New parenthetical comment indicates code is per eye; If both eyes, report twice DV & Associates, Inc.

  12. New Codes for 2011 • CPT 84112 Placental alpha microglobulin-1 (PAMG-1), cervicovaginal secretion, qualitative • Five organizations recommended CPT 82731 (fetal fibronectin ($92.26)) • Amnisure Rupture Of Membranes (ROM) test • Rapid, no instrument, qualitative, monoclonal antibodies • Immunochromatographic in vitro detection of the protein PAMG-1 • Present in cervico-vaginal discharge following rupture of the [fetal] membranes • Identify preterm labor DV & Associates, Inc.

  13. New Codes for 2011 • CPT 85598 Phospholipid neutralization; hexagonal phospholipid • Three organizations recommended CPT 85597 (platelet neutralization ($25.75)) • Confirmatory test for Lupus anticoagulants DV & Associates, Inc.

  14. CPT Description Changes 2011 • 85597 Platelet Phospholipid neutralization; platelet DV & Associates, Inc.

  15. New Codes for 2011 • CPT 86481 Tuberculosis test, cell mediated immunity antigen response measurement; enumeration of gamma interferon-producing T-cells in cell suspension • Four organizations recommended CPT 86480 (Tuberculosis test, cell mediated immunity measurement of gamma interferon antigen response ($88.77) and the other recommended CPT 86480 + 86359 (total T cells) ($142.80 total) DV & Associates, Inc.

  16. CPT Description Changes 2011 • 86480 Tuberculosis test, cell mediated immunity antigen response measurement; of gamma interferon antigen response DV & Associates, Inc.

  17. New Codes for 2011 • CPT 86902 Blood typing; antigen testing of donor blood using reagent serum, each antigen test • Four organizations recommended CPT 86903 (Blood typing; antigen screening for compatible blood unit using reagent serum, per unit screened ($13.52)) • New parenthetical comment indicates if multiple blood units are tested for the same antigen, code should be reported for each antigen for each unit tested DV & Associates, Inc.

  18. CPT Codes Deleted for 2011 • 86903 Blood typing; antigen screening for compatible blood unit using reagent serum, per unit screened DV & Associates, Inc.

  19. New Codes for 2011 • CPT 87501 Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, reverse transcription and amplified probe technique, each type or subtype • Three organizations recommended CPT 87798 (NOS ($50.27)) + 83902 (RT) ($70.60 total) DV & Associates, Inc.

  20. New Codes for 2011 • CPT 87502 Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for multiple types or sub-types, reverse transcription and amplified probe technique, first 2 types or sub-types • One organization recommended CPT 87798x2 and 83902x2 ($217.20) • Four organizations recommended CPT 87801 (multiple organisms PCR ($100.54)) + 83902 ($120.87 total) DV & Associates, Inc.

  21. New Codes for 2011 • CPT +87503 Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for multiple types or sub-types, multiplex reverse transcription and amplified probe technique, each additional influenza virus type or sub-type beyond 2 (List separately in addition to code for primary procedure) • Note add on code • One organization recommended CPT 87798 + 83902 ($70.60) • Three organizations recommended CPT 83901 + 83896 ($29.75) DV & Associates, Inc.

  22. New Codes for 2011 • CPT 87906 Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV-1, other region (eg, integrase, fusion) • Five organizations recommended CPT 87901 (genotype, nucleic acid, HIV-1, RT and protease ($368.73)) DV & Associates, Inc.

  23. CPT Description Changes 2011 • 87901 Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV-1, reverse transcriptase and protease regions DV & Associates, Inc.

  24. New Codes for 2011 • HCPCS G0432 Infectious agent antibody detection by enzyme immunoassay (EIA) technique, HIV-1 and/or HIV-2, screening • Four organizations recommended CPT 86702 (Antibody, HIV-1 and HIV-2, single assay ($19.65) DV & Associates, Inc.

  25. New Codes for 2011 • HCPCS G0433 Infectious agent antibody detection by enzyme-linked immunosorbent assay (ELISA) technique, HIV-1 and/or HIV-2, screening • Four organizations recommended CPT 86702 (Antibody, HIV-1 and HIV-2, single assay ($19.65) DV & Associates, Inc.

  26. New Codes for 2011 • HCPCS G0435 Infectious agent antibody detection by rapid antibody test, HIV-1 and/or HIV-2, screening • Four organizations recommended CPT 86702 (Antibody, HIV-1 and HIV-2, single assay ($19.65) DV & Associates, Inc.

  27. New CPT for 2011 • CPT 88749 Unlisted in vivo (eg, transcutaneous) laboratory service DV & Associates, Inc.

  28. CPT Description Changes 2011 • +82952 Glucose; tolerance test, each additional beyond 3 specimens (List separately in addition to code for primary procedure) • Note add on code DV & Associates, Inc.

  29. Reconsideration Request • CPT 84145 Procalcitonin (PCT) • No discussion detected • CLFS NLA $27.76 • Xwalk to calcitonin (82308) and $38.36 DV & Associates, Inc.

  30. Reconsideration Request • CPT 84431 Thromboxane metabolite(s), including thromboxane if performed, urine • No discussion detected • CLFS NLA $18.54 • Creatinine may also be billed $7.41 • Xwalk to TSH and $24.06 DV & Associates, Inc.

  31. Reconsideration Request • CPT 86352 Cellular function assay involving stimulation (e.g., mitogen or antigen) and detection of biomarker (e.g., ATP) • Two organizations recommended gapfill • Obtain costing information • Xwalk to phytomitogen (86353x2) + chemilluminescence (82397x2) = $180.92 DV & Associates, Inc.

  32. CPT Codes Deleted for 2011 • 89100 Duodenal intubation and aspiration; single specimen (eg, simple bile study or afferent loop culture) plus appropriate test procedure • 89105 collection of multiple fractional specimens with pancreatic or gallbladder stimulation, single or double lumen tube DV & Associates, Inc.

  33. CPT Codes Deleted for 2011 • 89130 Gastric intubation and aspiration, diagnostic, each specimen, for chemical analyses or cytopathology; • 89132 after stimulation DV & Associates, Inc.

  34. CPT Codes Deleted for 2011 • 89135 Gastric intubation, aspiration, and fractional collections (eg, gastric secretory study); 1 hour • 89136 2 hours • 89140 2 hours including gastric stimulation (eg, histalog, pentagastrin) • 89141 3 hours, including gastric stimulation DV & Associates, Inc.

  35. CPT Codes Deleted for 2011 • 89225 Starch granules, feces • 89235 Water load test DV & Associates, Inc.

  36. New CPT for 2011 • 88120 Cytopathology, in situ hybridization (eg, FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; manual • 88121 Cytopathology, in situ hybridization (eg, FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; using computer- assisted technology DV & Associates, Inc.

  37. New CPT for 2011 • CPT 88120 and 88121, Cont. • Parenthetical comments that morphometric FISH on non-urinary cytologic specimens apply to 88367 and 88368 • More than 5 probes should be coded with CPT 88399 • Parenthetical comment following CPT 88368 refers evaluation of urinary tract specimens to CPT 88120 or 88121 DV & Associates, Inc.

  38. CPT Description Changes 2011 • 88172 Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy of specimen(s)for diagnosis, first evaluation episode, each site • New parenthetical comment that an episode is a complete set of cytologic material submitted for evaluation and is independent of the number of needle passes or slides prepared. Separate episode occurs if the proceduralist obtains additional material from the same site based on the prior immediate evaluation or a separate lesion is aspirated DV & Associates, Inc.

  39. New CPT for 2011 • CPT +88177 Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, each separate additional evaluation episode, same site (List separately in addition to code for primary procedure) • Note an add on code • Resequenced DV & Associates, Inc.

  40. New CPT for 2011 • CPT +88177, Cont. • Parenthetical comment indicates the code is used when repeat evaluation episode(s) is required on subsequent cytologic material from the same site • Prior sampling not adequate DV & Associates, Inc.

  41. New CPT for 2011 • 88363 Examination and selection of retrieved archival (ie, previously diagnosed) tissue(s) for molecular analysis (eg, KRAS mutational analysis) • Review of archived sample to select blocks most appropriate for molecular study • Does not include microdissection or molecular interpretation DV & Associates, Inc.

  42. New Codes for 2011 • HCPCS G9143 Pharmacogenomic testing for Warfarin response • No recommendations detected • Xwalk to 83891 + 83896x3 + 83900 + 83901 + 83908x3 + 83912 = $172.76 DV & Associates, Inc.

  43. CPT Description Changes 2011 • +88332 Pathology consultation during surgery; each additional tissue block with frozen section(s) (List separately in addition to code for primary procedure) • Note add on code • Use with CPT 88331 • +88334 cytologic examination (eg, touch prep, squash prep), each additional site (List separately in addition to code for primary procedure) Note add on code; Use CPT 88334 with 88331, 88333 DV & Associates, Inc.

  44. Known Modifier Changes • Molecular Modifiers • ▲4A HLA-A* • ▲4B HLA-B* • ▲4C HLA-C* • (Modifier 4D has been deleted) HLA D • ▲4E HLA-DRB all • # ●4P HLA-DRB1* • # ●4Q HLA-DRB3* DV & Associates, Inc.

  45. Known Modifier Changes • Molecular Modifiers • # ●4R HLA-DRB4* • # ●4S HLA-DRB5* • ●4T HLA-DQA1* • ▲4F HLA-DQB1* • #● 4U HLA-DPA1* • ▲4G HLA-DPB1* • ▲4Z Histocompatiblity/typing, not otherwise specified DV & Associates, Inc.

  46. Known Modifier Changes • Genetic Modifiers Renumbering • # 4P Modifier is out of numerical sequence. See Modifier 4A-4Z • # 4Q Modifier is out of numerical sequence. See Modifier 4A-4Z • # 4R Modifier is out of numerical sequence. See Modifier 4A-4Z DV & Associates, Inc.

  47. Known Modifier Changes • Molecular Modifiers • # 4S Modifier is out of numerical sequence. See Modifier 4A-4Z • # 4T Modifier is out of numerical sequence. See Modifier 4A-4Z • # 4U Modifier is out of numerical sequence. See Modifier 4A-4Z DV & Associates, Inc.

  48. ICD-9 2011 • 287.4 Secondary thrombocytopenia • Add • 287.41 Post-transfusion purpura • 287.49 Other secondary thrombocytopenia DV & Associates, Inc.

  49. ICD-9 2011 • 780.6 Fever and other physiologic disturbances of temperature regulation • Add • 780.66 Febrile nonhemolytic transfusion reaction DV & Associates, Inc.

  50. ICD-9 2011 • 276.6 Fluid overload • Add: • 276.61 Transfusion associated circulatory overload • 276.69 Other fluid overload DV & Associates, Inc.

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