Laboratory Medicine: Coding, Reimbursement, and Regulatory Changes
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The document discusses coding and reimbursement changes for laboratory medicine in 2014, focusing on new therapeutic drug assay codes and their financial implications. It highlights specific codes related to drugs like caffeine, clozapine, everolimus, gabapentin, and lamotrigine, including details on their methodologies and reimbursement rates. The presentation also addresses regulatory programs affecting payments and compliance issues in the context of these changes.
Laboratory Medicine: Coding, Reimbursement, and Regulatory Changes
- 1. Laboratory Medicine: Coding, Reimbursement, and Regulatory Changes Discussion on Final Changes Related to the Outpatient Prospective Payment System, Medicare Physician Fee Schedule, and more! Presenter - Diana W. Voorhees Follow us :
- 2. Objectives DV&ASSOCIATES,INC. 2 Discuss procedural and diagnostic coding changes for 2014 Describe reimbursement reality for 2014 Discuss programs that present payment limitations including the NCCI, local coverage determinations, MUEs, and payer variances As time permits, discuss additional coding, billing, and reimbursement compliance concerns
- 3. New Codes - CLFS Therapeutic Drug Assays DV & ASSOCIATES, INC. 3 80155 Therapeutic Drug Assay; Caffeine Xwalk to CPT 82491 (Chromatography quant single) or 80198 (theophylline) $19.45 - $24.82 (2014 NLA $19.30) CMS: Crosswalk to 80198 Two drug molecules are closely related, part of the same chemical family, the methylated xanthines. The assay kit for caffeine is similar in methodology (immunoassay) to the assay of theophylline. Crosswalking to chromatography is not consistent with how the assay of caffeine can be performed.
- 4. New Codes - CLFS Therapeutic Drug Assays DV & ASSOCIATES, INC. 4 80159 Therapeutic Drug Assay; Clozapine Xwalk to CPT 80154 (: Assay of benzodiazepines $25.43 (2014 NLA $24.23) CMS: Crosswalk to 80154 Two drug molecules used in treating psychosis and other indications are closely related. This kit is similar in methodology to the assay of benzodiazepines.
- 5. New Codes - CLFS Therapeutic Drug Assays DV & ASSOCIATES, INC. 5 80169 Therapeutic Drug Assay; Everolimus Xwalk to CPT 80195 (sirolimus), 82542 (Column chromotography quant), or 80158 (cyclosporine) $18.87 - $24.82 (2014 NLA $18.73) CMS: Crosswalk to 80195 Both drugs used for immune suppression, for example, in patients who have received transplants. A recent everolimus assay was cleared in 2013 by FDA for use in kidney transplant patients. This kit is similar in methodology (immunoassay) to the assay of sirolimus. Crosswalking to chromatography for cyclosporine is not consistent with how the assay of everolimus can be performed.
- 6. New Codes - CLFS Therapeutic Drug Assays DV & ASSOCIATES, INC. 6 80171 Therapeutic Drug Assay; Gabapentin Xwalk CPT to 82491 (Chromotography quant single) or 80157 (carbamazepine free) $18.22 - $24.82 (2014 NLA $18.09) CMS: Crosswalk to 80157 Two drug molecules with anticonvulsant and other uses, are of similar molecular weight. The assay kit for gabapentin uses a similar methodology (immunoassay) to that (EMIT) used in assay for free carbamazepine (FDA cleared in 1993). Crosswalking to chromatography is not consistent with how the assay of gabapentin can be performed.
- 7. New Codes - CLFS Therapeutic Drug Assays DV & ASSOCIATES, INC. 7 80175 Therapeutic Drug Assay; Lamotrigine Xwalk to CPT 82542 (Column chromotography quant) or 80157 $18.22 - $24.82 (2014 NLA $18.09) CMS: Crosswalk to 80157 Two drug molecules are closely related, with anticonvulsant and other uses. The assay kit is based on a similar methodology (immunoassay) to that used for free carbamazepine. Crosswalking to chromatography is not consistent with how the assay of lamotrigine can be performed.
- 8. To see the complete presentation check the below link: http://www.audioeducator.com/pathology/laboratory-medicine-06-19- 14.html