Andrea: Georgia's LMRP for flow has been in place since April '97. The original policy was similar to what you're describing, with ICD-9 codes for known hematolymphoid malignancies included, and those that correspond to presenting problems with a high frequency of hematolymphoid malignancies (pancytopenia, lymphadenopathy, etc.) excluded. All well and good if I could document that the pancytopenia was due to AML or a T cell lymphoproliferative disorder, but otherwise problematic. You can view the policy at: http://www.gamedicare.com/Policies/197.htm Note that lymphadenopathy (785.6) and "other lymphatic and hematopoietic tissues" (238.7) were both added in December '97, but it was still far from optimal. Early last year I enlisted the suppport of the Georgia Society for Clinical Oncology and together we approached our local Medicare part B provider. In the end we managed to convince them to revise our LMRP to include ICD-9 codes that cover most of the pertinent clinical situations (effective May '01). The rationale for using flow in these situations must be documented in the patient's medical record. Use of 285.9 (for anemia), for instance, is appropriate only when common causes of anemia such as iron deficiency have been ruled out. As virtually all of this sort of sample comes from oncologists' we feel comfortable that this documentation is occurring. I would be much less comfortable accepting these samples if they came from internists or surgeons or whatever. Our Medicare provider was initially hesitant to include these codes, seeing the potential for tremendous abuse, both intentional and unintentional. We have noticed no difference in our case mix or client mix since the change in policy. Our volume continues to rise steadily, but there's been no big jump. My lab is part of a university healthcare system, with the entire entity being "not for profit". Increased volume in the lab doesn't mean more money for me (and not a lot more for the institution, as we deliberately keep our margin low), just more work, so there's no incentive for us to abuse the new codes. Jeannine Holden Director, Flow Cytometry Lab Emory Medical Laboratories Atlanta, GA ***************************************************************************** Dear group, The hospitals we serve as a Flow Cytometry reference laboratory seem to have some issues regarding Medicare reimbursement due to the ICD9 code being used. The scenario is a follows: The flow lab receives a lymph node with the suspected diagnosis of r/o lymphoma. The lab does the analysis but finds no evidence of a lymphoproliferative disorder. If the hospital (or whoever is asking to be reimbursed) uses the "correct" ICD9 code of lymphadenopathy, they don't get reimbursed (since the code is not part of the LMRP. If they use the Suspected diagnosis code (lymphoma), this could be construed as a false claim. One of our pathologists is in the process of writing to the Fiscal Intermediary to include lymphadenopathy and enlarged lymph nodes as an acceptable diagnosis added to the LMRP. Another problem area is also when we get a bone marrow "for flow" (the kind of see-what-you-can-find type of thing). Which code do we use when we don't find anything malignant and still would like to get reimbursed? Any thoughts or insights from the billing experts on this issue are much appreciated. Thank you - Andrea Illingworth, MS Dahl-Chase Dx Services - Flow Cytometry 333 State Street Bangor, Maine 04401
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