ASCP and CAP ask CMS to reconsider 88305 and molecular pathology decisions

CMSBoth the CAP and ASCP have recently written letters to CMS, urging it to reconsider its decisions to slash 88305 reimbursement and to place molecular pathology codes on the Clinical Laboratory Fee Schedule (CLFS) and not the Physician Fee Schedule (PFS).  I very much appreciate the fact both organizations are continuing to advocate for better treatment from CMS.

Both organizations have summarized the content of their letters-ASCP in its January 2013 ePolicy News and CAP in its most recent STATLINE.  I will post the full letters at the bottom of the post for those interested.  They both do a very nice job of explaining what all went in to CMS’s decisions, and why those decisions are suboptimal from an organized pathology perspective.

Although the letters are certainly similar in content, they diverge enough to make reading both worthwhile.

Here are some of the more interesting points:

-CMS essentially blind-sided the profession of pathology by announcing the 88305 reimbursement cut in its final rule and not its proposed rule, thereby precluding stakeholders from submitting public comments

-CMS erroneously rejected multiple recommendations from the Resource-based Relative Value Scale Utilization Committee (RUC) related to direct practice expenses, including costs for specimen, solvent, and formalin disposal (CMS recognizes the cost of the actual solvents, but not their disposal); courier transportation; equipment maintenance cost; computer system and maintenance contract; and software

-CMS should phase the reimbursement cuts in over at least a three year period

-CoPath costs between $120,000-$150,000, is unique to the practice of anatomic pathology, and should be included in the direct practice expense inputs for the 88300-88309 codes

-The CAP, with the help of four other professional organizations, looked at 411 88305 cases and found the median number of blocks needed was 4.  (Two of the organizations were dermatopathology-related, so no doubt there were a lot of multi-block skin excision cases)

-The placement of molecular codes on the CLFS will hurt patient care, as fewer pathologists will go into molecular pathology

-There is no review process for tests on the CLFS, meaning the value of molecular tests will not be adjusted

-The MolDx program created by Palmetto GBA to “modify coverage and reimbursement policies for certain molecular diagnostic laboratory tests” violates HIPAA, exceeds Palmetto’s authority and should be stopped immediately

ASCP letter to CMS

CAP letter to CMS

Comments

  1. dr.cosell says:

    The uropathologists who promoted 12 and more separate prostate biopsies and the urologists with their own histology labs who couldn’t find a prostate they didn’t want to biopsy can claim responsibility for the drastic reduction in the TC for the 88305. Greed, pure and simple.

  2. dr st paula says:

    the dermatologists too!!! are you kidding dr cosnell. the dermatologists have done just as much if not more damage. its been going on for decades. it is not as important to you because it seems like your emphasis in your practice is not dermatopathology or no one wants to take on the AAD task force and their marquis dermatology trained dermatopathologists. there is a lab right now that is doing 350,000 skins in an in-house lab that has over 60 offices loosely affiliated some by management service agreements just so they can get labwork and navigate around the stark law and call it “in-house” labwork. give me a break. their models are similar and they all center around getting the labwork and pretend like they are not “outside referrals”. three big derm-lab companies two of which are multi-state all centered around getting “in-house” labwork. AD, ID, FD. total skin biopsy count close to 800,000 biopsies! thats just three companies that buy derm clinics or have weak MSAs just to get the labwork. what a racket. you have not seen greed until you have seen those dermatologists in action. dont give these derms a free pass!

  3. dr st paula says:

    one derm DP with five clinics and an in-house lab is doing S100 and pan-mel on every single junctional nevus. another derm DP with seven clinics and an in-house lab is doing HPV on every skin wart and Ki67 on every AK. another derm with an inhouse lab and DP whore and 60 nursing homes is forcing his PAs and nurses to take at least two biopsies on every patient by offering them bonuses for taking more biopsies. come on. .i guarantee the unnecessary derm biopsies far out number the unnecessary prostate biopsies. at least Bostwick is a pathologist. the derms have one year of pathology training and have single handley destroyed our specialty. i guarantee the CMS had the derms in mind when they slashed the fee code. they have destroyed our specialty and hard working honest pathologists around the nation. they are already firing pathologists coast to coast north to south. that TC is coming right out of the salaries of the pathologists. the sick part is thats its been months since i have been on this blawg and no one cares but a hand full of people. pathetic. what a sad bunch with no backbone. and what about the TC grandfather clause. do you have any idea the havoc that is wrecking with those crooked hospital CFOs that wont pay their lab bills. pathology is the canary in the coal mine…they are going to systematically destroy all the specialties. this is just the beginning of the havoc they are going to wreck on medicine. the government doesnt want to referee between specialties. why should they waste the resources. tracking crooks, refining the law and investigating the kickbacking. its easier just to chop it all down! YOU WILL GET your precious prostate biopsies back one day when they really want to know if its cancer but you are not going to get paid much for it.

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