Pathology/Lab Coding Alert

Hang on to 'grandfather' exception, too.

You won't face a 27 percent Medicare pay cut starting Jan. 1 after all -- at least not for two months. That's because the rate reduction was once again kicked to the curb by Congress, resulting in a Medicare Physician Fee Schedule conversion factor of $34.0376 through Feb. 29.

On Dec. 23, the House followed the Senate's lead in voting to halt the Medicare pay cut for two months, which will freeze Medicare pay at 2011 rates through the end of February.

Problems aren't over: Although Medicare pay is now set to drop on March 1, the AMA is hopeful that Congress will find a longer-term solution before then. "With this brief reprieve from the massive 27 percent cut to Medicare payments, Congress now has to enact a real and fiscally responsible solution to this sorry cycle of scheduled cuts and short-term patches that compromises access to care for patients and drives up costs for taxpayers," AMA President Peter W. Carmel, MD, said in a statement. "Members of Congress need to use this time to work in a bipartisan manner to provide long-term stability for seniors, military families and the physicians who care for them."

RVU cuts took effect: Keep in mind that the Congressional vote only adjusted the conversion factor for 2012 (which had been set to drop by 27 percent on Jan. 1). Other changes slated for Jan. 1 -- for instance, RVU adjustments printed in the 2012 Medicare Physician Fee Schedule Final Rule -- did take effect.

Continue Billing TC to Medicare

The legislation also extends the pathology technical component (TC) "grandfather" exception for two months.

Under the grandfather exception, you can continue to bill Medicare directly for the TC of pathology services provided for hospital inpatients and outpatients -- but only if your independent lab is operating under arrangements with a covered hospital that were in place as of July 22, 1999. Congress has extended the grandfather exception each year since that time.