[Histonet] RE: NCCI policy update plus copper stain CPT change

Sat Dec 31 13:52:16 CST 2011

Like I said before, the organizations I have been with did not choose to do that because of the medically necessity laws that governed that. The Pathologist would have to document the necessity of billing for lets say a keratin done on blocks A1, A2 and A3 on a sentinal node. we always billed for just one keratin.These are large institutions/path groups I am refering to.Were they cheating themselves or being medically prudent? Not sure. Also, within the past two years Ive had the pleasure of being subjected to sitting within a group called code correct who helps hospitals stay in compliance. apparently that group did not like the pratice of billing for A1, A2 keratins as well. Bill for A, B, C etc yes. 

Perhaps the Pathologist sitting in this forum can explain it better as to why some Paths who are medical directors choose to not bill for multiple blocks on the same specimen unless they had a out right hard core reason to need it, rare in deed from what Ive seen. Ive had more than one argument on why cant we bill for the clot and make it part type B instead of making it block A2. Ive seen this practice of what im saying over the past 5 years at 2 large hospitals and 2 large private path groups that were the medical directors of the hospital labs. So I can only speak from what Ive seen. 

To say the least is I guess these places are better prepared for this change if in fact they self punished themselves from this practice of billing multiple blocks of same samples. 

but this new billing for using cocktails on one sample and being able to bill one is a whole nother ball game. 

I imagine its going to hit urology groups hard since vendors have been selling the P504s, racemase, 34Be12 cocktails real hard last few years. 

With all this said, I am sitting here laughing at myself. We all can only say what we have personally experianced. and whats funny to me is we think about work too much lol..... 

We should be having a nice cold one. We'll survive somehow with what ever they toss at us. :) 

Happy New Year Histonetters.... Luv Ya!

Kim D

________________________________
From: "Weems, Joyce" <JWeems <@t> sjha.org>
To: Kim Donadio <one_angel_secret <@t> yahoo.com>; Lester Raff MD <LRaff <@t> uropartners.com>; Jesus Ellin <JEllin <@t> yumaregional.org>; "histotech <@t> imagesbyhopper.com" <histotech <@t> imagesbyhopper.com> 
Cc: "histonet <@t> lists.utsouthwestern.edu" <histonet <@t> lists.utsouthwestern.edu>; "Webb, Dorothy L" <Dorothy.L.Webb <@t> HealthPartners.Com> 
Sent: Saturday, December 31, 2011 1:03 PM
Subject: RE: [Histonet] RE: NCCI policy update plus copper stain CPT change

For the past two years we have been able to bill immunos and special stains per block. This will be a loss for for the big cases that need multiple blocks stained since the cost is per slide, not specimen. I don't see anything about the special stains tho - doesn't make sense. 

Global billing is technical and professional charges combined and would have include the separate blocks. 

NOTE: The CPT code has changed for the copper stain - 88318. It is now in the non-microbial group - 88313. 

Happy New Year Everyone!! j

________________________________________
From: histonet-bounces <@t> lists.utsouthwestern.edu [histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Kim Donadio [one_angel_secret <@t> yahoo.com]
Sent: Saturday, December 31, 2011 12:13 PM
To: Lester Raff MD; Jesus Ellin; histotech <@t> imagesbyhopper.com
Cc: histonet <@t> lists.utsouthwestern.edu; Webb, Dorothy L
Subject: Re: [Histonet] RE: NCCI policy update

The practice of billing for seperate blocks on one specimen such as A1, A2 and A3 I beleive has long been gone. At least in the organizations I have been with. What seems to be new is they are going after the new trend of using cocktail antibodies. I agree you would think that ASCP and CAP would be on top of this. While i might see the argument that the technical component could be reduced in using these cocktails, I cant see how they think it will benefit anyone for not allowing the fee for each antibody read out on one slide from the Pathologist. I realize most places bill global fee's, so that's a issue that would need to be looked at how to deal with it. But it is a bit unfair when you consider sometimes you only have one tiny little specimen, or maybe even one slide to stain and you need multiple markers. You could even argue that the cost of using cocktails is more expensive for your technical component. If what they do is force labs to go back to
using one slide per anibody, I dont feel thats a betterment in healthcare pratcice since sometimes tumor cells are limited to one or two slides per specimen. We've all seen it i'm sure. With all that said, with everything coming down the pipelines at us healthcare professionals, we need to buckle up. It's getting ugly out here.They used to want us (healthcare professionals) to do a lot for a little bit, now its do everything with nothing. There I said it.

Kim Donadio

________________________________
From: Lester Raff MD <LRaff <@t> uropartners.com>
To: Jesus Ellin <JEllin <@t> yumaregional.org>; histotech <@t> imagesbyhopper.com
Cc: histonet <@t> lists.utsouthwestern.edu; "Webb, Dorothy L" <Dorothy.L.Webb <@t> HealthPartners.Com>
Sent: Saturday, December 31, 2011 10:56 AM
Subject: RE: [Histonet] RE: NCCI policy update

Below is the quote from the new NCCI guidelines that deal with this issue.  I am amazed that CAP and ASCP, have not been 1) notifying members and 2) disputing this change.

"The unit of service for immunohistochemistry (CPT codes 88342, 88360, 88361) is each antibody(s) stain (procedure) per specimen. If a single immunohistochemical stain (procedure) for one or more antibodies is performed on multiple blocks from a surgical specimen, multiple slides from a cytologic specimen, or multiple slides from a hematologic specimen, only one unit of service may be reported for each separate specimen. Physicians should not report more than one unit of service per specimen for an immunohistochemical antibody(s) stain (procedure) even if it contains multiple separately interpretable antibodies"

Lester J. Raff, MD
Laboratory Medical Director
UroPartners Laboratory
2225 Enterprise Dr Suite 2511
Westchester, IL 60154
Phone: 708.486.0076
Fax:  708.492.0203

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu on behalf of Jesus Ellin
Sent: Fri 12/30/2011 4:18 PM
To: histotech <@t> imagesbyhopper.com
Cc: histonet <@t> lists.utsouthwestern.edu; Webb, Dorothy L
Subject: Re: [Histonet] RE: NCCI policy update

Don't you think we havea hand in this reporting out this CPT code so much,, I would expect this to be bundled here soon in a DRG for pathology services,, that's where it is headed.

Sent from my iPad

On Dec 30, 2011, at 2:22 PM, "histotech <@t> imagesbyhopper.com" <histotech <@t> imagesbyhopper.com> wrote:

> Wow.  What made them change their minds?  There are many times when we stain
> different blocks of a single specimen and only one lights up.
>
> I, too, would be interested in an official document stating the change.
>
> Thanks!
> Michelle
>
> -----Original Message-----
> From: histonet-bounces <@t> lists.utsouthwestern.edu
> [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Amber
> McKenzie
> Sent: Friday, December 30, 2011 3:07 PM
> To: Martha Ward-Pathology; Webb, Dorothy L;
> 'histonet <@t> lists.utsouthwestern.edu'
> Subject: [Histonet] RE: NCCI policy update
>
> Where can I get the article to show my billing dept/pathologists?
>
> -----Original Message-----
> From: histonet-bounces <@t> lists.utsouthwestern.edu
> [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Martha
> Ward-Pathology
> Sent: Friday, December 30, 2011 1:13 PM
> To: Webb, Dorothy L; 'histonet <@t> lists.utsouthwestern.edu'
> Subject: [Histonet] RE: NCCI policy update
>
> Oh yes, we are very aware and quite upset at the change!
>
>
> Martha Ward, MT (ASCP) QIHC
> Manager, Molecular Diagnostics Lab
> Dept. of Pathology
> Wake Forest University Baptist Medical Center Winston-Salem, NC 27157
> 336-716-2104
>
>
>
> -----Original Message-----
> From: histonet-bounces <@t> lists.utsouthwestern.edu
> [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Webb,
> Dorothy L
> Sent: Friday, December 30, 2011 1:33 PM
> To: 'histonet <@t> lists.utsouthwestern.edu'
> Subject: [Histonet] NCCI policy update
>
> Is everyone aware that beginning 1/1/12, we can no longer bill for each
> block regarding IHC billing, only one unit of billing for each part type no
> matter how many blocks are stained?  Also IHC "cocktail" stains, such as
> PIN4 must now be billed as one unit even though multiple antibodies are
> reported out.
>
> Kind of a surprising reversal of the policy set in motion 10/1/2009.
> SPECIMEN becomes the unit of service rather than block(s) for IHC codes
> 88342, 88360, and 88361.
>
> Happy New Year to everyone out there.  May 2012 find you happiness and
> health!
>
> Dorothy Webb, HT
> Regions Histology TS
> 651-254-2962
>
>
>
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