Hi All! I thought I'd pass along this tidbit of information for all the US clinical cytometrists who have to deal with the wonders of reimbursement. This was sent to me from Robin Stombler, the Director of ASCP in Washington DC, in response to a question which was raised during her presentation at a recent meeting on the new Prospective Payment Plan for outpatient services which is currently being negotiated. The Negotiated Rulesmaking committee is made up of representatives from multiple organizations whose constituents would be affected by these decisions, ASCP being one of them. They are charged with role of coming to an agreement of how reimbursement for outpatient services will be handled in a standardized manner nationwide. It appears that what they have done is taken CPT codes and grouped them into like categories of services called APCs. Each APC will have a specific reimbursement rate. APC 0344 contains the infamous CPT code 88180, hence the question. Since Robin is representing ASCP on this committee she would be very interested in any comments or feedback on these issues. Her e-mail address is below. Joanne Thomas, M.S. Director of Operations TRITECH Field Engineering 2014 Renard Court, Suite I Annapolis, MD 21401 1-800-886-7004 (USA) 1-410-266-1522 410-266-0935 (FAX) thomas@tritechinc.com -----Original Message----- From: rstombler <rstombler@ascpwash.org> To: cyto-inbox Date: Wednesday, August 16, 2000 9:49 AM Subject: APC 0344 response >Joanne - > >Since we have received many questions regarding the billing of cell tumor >markers under the hospital outpatient prospective payment system, we are >planning to publicize broadly the following question and answer. You are >welcome to distribute to AMLI members as well. >Thanks for the example! > >- Robin >========================== >To assist you further, please find below the general question, and the >response from the Health Care Financing Administration. > >Question: It was pointed out that bone marrow, peripheral blood, or lymph >node samples may be taken on an outpatient basis for a leukemia/lymphoma >work up. A panel of antibodies (markers) is chosen based on the clinical >presentation and other laboratory data. Under the system of CPT coding, one >88180 CPT would be billed for each marker used in the panel, so if 10 >markers are used then 10 x CPT 88180 code are billed. The reimbursement >amount is set for "each marker" and is the same regardless of the antibody >used. > >If, under the hospital outpatient prospective payment system, APC 0344 is >reimbursed at $38, and CPT 88180 is part of this APC, does that mean a >laboratory would be reimbursed $38 regardless of the number of markers used >or would it work the same as it would under the former system where 10 >charges would be made at $38 each? > >Answer: "Code 88180 represents the code to be billed for .... " each cell >surface >marker." Therefore, one unit should be billed for each marker and the >bill >will be paid based on multiple APC payments (i.e., one APC for each unit >billed)." > > >
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