Association for Molecular Pathology                       
Newsletter                                                                    
February 2010, Volume 16, Number 1 

Economic Affairs Committee Report

By Jeffrey A. Kant MD, PhD Chair, Economic Affairs Committee e-mail: kantja@upmc.edu

Economic Affairs Committee (EAC) had a full and successful year in 2009 and all indications are 2010 will be no different. 

CPT Code Reform
EAC’s premier accomplishment was drafting a CPT coding reform proposal for molecular tests in the areas of oncology and genetics to deal with problems of transparence and confusing units of service associated with the ‘procedural codes’ in the 83890 – 83914 series.  This was facilitated by an unrestricted educational grant from Abbott Diagnostics which permitted the Committee to hold several face-to-face meetings to hammer this out.  The importance (and timeliness) of this document was confirmed when the AMA CPT Editorial Panel decided to convene a Workgroup on problems (see above) associated with coding for molecular assays.  The Workgroup at its initial meeting about a month ago adopted the AMP proposal as the framework for further discussion.  As reported at the 2009 Annual Meeting, the highlights of the reform proposal are:

• Define assay-specific CPT codes independent of method (e.g. factor V Leiden) for commonly-performed tests or others for which transparency is important
• Define multiple ‘complexity level’ CPT codes for specific molecular tests based on resources required for technical and interpretive components.  This is similar to the current 6-level system used for surgical pathology specimens (88300-88309) and will likely draw at least loosely on principles used for evaluation and management (E&M) codes.
• Each CPT code will all be charged as a single unit of service; no more amplification x 59 for analysis of complex genes which payers never could figure out.

This process continues at the first CPT Editorial Panel Meeting this year in mid-February.  EAC has other longer term objectives we are hoping will also come out of this process.  I will go into some of those other projects in later Newsletter Columns this year.

CPT Code Proposals
AMP was successful in obtaining a CPT for bacterial identification via DNA sequencing (87153).  Instead of adopting the laboratory community’s recommendation to crosswalk this to the value for hepatitis C genotyping which involves pretty much identical work, CMS crosswalked this to a combination of technical and interpretive codes and will reimburse this code on the 2010 CMS Clinical Laboratory Fee schedule up to $165.22.

Coding and Coverage Corner (C³)
In response to member questions raised in connection with the annual Coding Conundrums session at the AMP Annual Meeting or otherwise received, the Committee will periodically issue comments to clarify areas where it believes there is clear or substantial evidence of how to correctly code molecular assays or portions of assays. With the successful completion of the coding reform initiative mentioned above, presumably there will be less to discuss in the ‘Corner’ in several years! 

Committee Membership
EAC is particularly thankful to departing members Andrea Ferreira-Gonzalez and Jean Amos Wilson (ex officio from Professional Relations Committee) for their service to the Committee.  EAC had 13 applicants express interest in response to a call to the membership in December.  Samuel Caughron and John Ten Bosch have been added as regular and junior members, respectively, and a third new member will be chosen soon.  The names of others kept at the ready for Committee work groups or projects that enlist other AMP members who are not officially part of EAC.