Editor's note: Facilities need to address coding, payment, and coverage issues for molecular pathology. This article is the first in a series and discusses molecular pathology coding.
One of the major changes to the 2013 CPT Manual is the replacement of the term "physician" with "physician or other qualified healthcare professional" (QHP) in a wide range of codes.
Radiation oncology uses high-energy radiation to shrink or kill tumors or cancer cells with minimal harmful effects to healthy surrounding cells. To correctly code for radiation oncology services, coders need to understand the various elements of the treatment.
When outpatient hospitals and physicians switch to ICD-10-CM diagnosis codes October 1, they will still continue to use CPT ® codes to report procedures. But some facilities are planning to use the new procedure code set, ICD-10-PCS, as well.
The AMA revised the molecular pathology codes in the CPT ® Manual in 2012, but at that time CMS did not adopt the codes as it was still debating whether and how to change the reimbursement system for these services going forward. For CY 2013, CMS elected to recognize the codes, which meant it had to finalize how to pay for them. While CMS did not change pamyent for these services under the Clinical Laboratory Fee Schedule (CLFS) despite industry pressure, its change to the new codes means a change in the payments providers can expect this year and in the future.
E/M coding and reimbursement for hospital outpatients could change dramatically if CMS finalizes its proposal to replace current E/M CPT ® codes with three G-codes.
