Pathology/Lab Coding Alert

Payment rates are just the tip of the iceberg in the 2003 Physician Fee Schedule. Looming beneath the surface are payment and coding policies that labs must heed to receive proper reimbursement.

With direction about how to use specific CPT Codes and the addition of several new HCPCS Level II codes , you can't afford to ignore Medicare's policy instructions published in the Dec. 31, 2002, Federal Register. Coding for fine needle aspiration (FNA) surgical procedures, stem-cell transplants, and home prothrombin time (PT), among others, requires knowledge of the new CMS rules. CMS Writes Its Own Stem-Cell Codes Although CPT 2003 provides sweeping changes to stem-cell transplant coding (see "Stem-Cell Codes Add Up to Accurate Reimbursement" in the January 2003 Pathology Lab Coding Alert), Medicare will not recognize many of the new codes.

Medicare will not pay for the new management code 38204 (Management of recipient hematopoietic progenitor cell donor search and cell acquisition), giving it a "B" status indicator in the fee schedule. "This code represents a whole new way of thinking about physician work," says Samuel Silver, MD, PhD, medical director of the Cancer Center Network at the university of Michigan and representative of the American Society of Hematology on the AMACPTAdvisory Committee.

Finding an unrelated donor requires a lot of work by the physician, yet it doesn't occur face-to-face with the patient, as do most procedures, Silver says. CMS provides no substitute code for this service because it believes that the physician management is already incorporated in the other transplant service codes (for example, 38205-38206 and 38240-38242). Similarly, CMS rejects new codes 38207 (Transplant preparation of hematopoietic progenitor cells; cryopreser-vation and storage), 38208 ( thawing of previously frozen harvest) and 38209 ( washing of harvest) as an "unbundling of existing codes 88240 (Cryopreservation, freezing and storage of cells, each cell line) and 88241 (Thawing and expansion of frozen cells, each aliquot). Because CPT2003 directs coders to use 88240 and 88241 only for diagnostic services beginning Jan. 1, CMS created two HCPCS Level II codes to report these procedures when carried out for Medicare beneficiaries receiving stem-cell transplant services. They are G0265 (Cryopreser-vation, freezing and storage of cells for therapeutic use, each cell line) and G0266 (Thawing and expansion of frozen cells for therapeutic use, each aliquot). Medicare also rejects other new codes in the 38207 family that describe specific cell depletion or concentration (38210-38215). Because CPT2003 deleted the single code that these six codes replaced (86915, Bone marrow or peripheral stem cell harvest, modification or treatment to eliminate cell type[s] [e.g., T-cells, metastatic carcinoma]), CMS also provides a new G code for this service G0267, [...]