Association for Molecular Pathology                       
Newsletter                                                                    
May 2009, Volume 15, Number 2 

Economic Affairs Committee Report

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

What was previously the ‘CPT Coding Subcommittee’ of the Professional Relations Committee has morphed, following Council approval, into the Economic Affairs Committee (EAC).  A bylaws amendment recognizing EAC as a standing committee will be submitted to the membership for consideration with the election ballot later.  Jan Nowak ably chaired this group until February 1 when the responsibility was passed to me so Jan could focus on the AMP Presidency.  Replacing Jan as the AMP representative to the Pathology Coding Caucus (PCC) is Aaron Bossler.

An appreciation of the importance of economic-related matters to the discipline and membership led to the establishment of this Committee in early 2008.  Here is what we have been doing:

1. Last year a cross-organization workgroup (led by Aaron) which included American Society for Microbiology (ASM), American Clinical Laboratory Association (ACLA) and a group of knowledgeable people in coding and reimbursement developed a CPT code proposal for bacterial identification via DNA sequence analysis.  After discussion and revision at the PCC, the proposal appeared to be well-received at the CPT Editorial Panel meeting in February, and we are hopeful there will be a dedicated CPT code to address this area in 2010.  For this year we plan to resurrect this workgroup to discuss genotyping assays for additional viruses beyond HIV-1 and HCV, and possibly to discuss the area of multiplex viral assays.  In our discussions we are ever mindful of the adage “be careful what you wish for.”  Member suggestions for other areas needing CPT attention are welcome; we will prioritize and do what we can.  These initiatives require considerable effort to realize.
    

2. EAC has also been discussing models to ‘simplify’ CPT coding for molecular diagnostic assays.  The Abbott Diagnostics Foundation has graciously provided support for several face-to-face meetings of the Committee as they have worked on this project.  Assay costs for technologies which might fall into common ‘bins’ are being investigated.  Joan Logue led EAC efforts to analyze cost data for Factor V Leiden testing, and we are now collecting information for lower volume and higher complexity assays such as immunoglobulin heavy chain rearrangement or DNA sequence analysis for genetic disorders.  An update on these activities will be available by the time of this year’s Annual Meeting.
    

3. EAC has initiated contacts with a carrier medical director for a large Medicare jurisdiction which led to withdrawal of a poorly-worded and penalizing local coverage determination for genetic testing.  Efforts continue to have this coverage decision rescinded or reconsidered/revised in other jurisdictions.
    

4. A suggestion was made to develop a ‘column’ for the Newsletter around examples or issues associated with CPT coding and reimbursement.  The first installment of this new feature, “Show Me the Money!” is a piece I prepared for the CAP CPT Coding Tutorial describing the two major types of coverage decisions that govern how labs get paid for Medicare services.  Ideas for subsequent columns are welcome and encouraged.