Economic Affairs Committee Report
By Jeffrey A. Kant, MD, PhD
Since Economic Affairs Committee’s (EAC) last report to the membership, a significant fraction of Committee time has been devoted to discussion of general and specific issues around CPT Code reform for molecular testing related to oncologic and heritable disorders. A number of Committee members are active participants in the AMA CPT Editorial Panel Workgroup which is considering this area. The Workgroup meets regularly by conference call and holds public (confidentiality disclosure required) meetings at CPT Editorial Panel Meetings. The winter meeting of the Workgroup was held in mid-February in Naples, Florida. Confidentiality agreements associated with the overall Workgroup process do not allow public discussion of details, but it is likely additional specific information will be available later this year, and coding changes could be seen as early as the 2012 calendar year.
In parallel with CPT code reform efforts, EAC has been discussing and coordinating AMP’s participation in a coalition of professional organizations seeking legislative recognition for PhD laboratory scientists having appropriate molecular training as ‘qualified healthcare practitioners.’ Qualified healthcare practitioners can bill for professional component reimbursement for relevant molecular CPT codes on the Physician Fee Schedule (PFS). There has been excellent discussion and cooperation, to date, on this delicate issue, and it is likely sponsors for necessary legislative authorization will be sought in the current Congress. Given current emphasis on limited or no new spending, CBO scoring of such an initiative will be important, and the coalition has retained an advisor to work with us on preparing materials for that process.
Aaron Bossler continues to represent AMP on the Pathology Coding Caucus (PCC), which discusses and typically offers opinions on all laboratory-related CPT Code Change Proposals (CCPs) being considered by the CPT Editorial Panel. EAC will be coordinating with select members of the Clinical Practice Committee Respiratory Virus Workgroup to consider a CCP for multiplex viral testing, an emerging assay format for which unambiguous CPT codes are not current available.
Samuel Caughron will be overseeing the EAC web page. Please send Sam or me suggestions for things or resources you think would be useful for members on that page.