Another reimbursement complaint

[y2k_free_radical]

Why are lung,breast and and bone marrow biopsies only 88305s and why are prostate biopsies and breast lumpectomies reimbursed at such a low rate ? Does the CAP have any input in the values assigned ?

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[pathstudent]

Why are lung,breast and and bone marrow biopsies only 88305s and why are prostate biopsies and breast lumpectomies reimbursed at such a low rate ? Does the CAP have any input in the values assigned ?

BUt on the bright side placentas are 88307s.

 

[deleted314957]

Why are lung,breast and and bone marrow biopsies only 88305s and why are prostate biopsies and breast lumpectomies reimbursed at such a low rate ? Does the CAP have any input in the values assigned ?

I thought this would be apparent.
The federal government and the insurance companies ( the "payors") call the
tune. We have no pricing power. The AMA works with the Feds regarding
CPT coding and CAP supposedly has their input, but it is a tiny voice in the wilderness.
None of the payors care how much work/effort goes into our work.
They do it because they can. No mystery here.

 

[jupiterianvibe]

I thought this would be apparent.
The federal government and the insurance companies ( the "payors") call the
tune. We have no pricing power. The AMA works with the Feds regarding
CPT coding and CAP supposedly has their input, but it is a tiny voice in the wilderness.
None of the payors care how much work/effort goes into our work.
They do it because they can. No mystery here.

The CAP, which represents the biglabs, negotiates these rates as being sufficient for biglab operation, provided the market is overrun with expendable labor. This is probably the true nature of the oversupply and proliferation/persistence of bad programs.

 

[icpshootyz]

Why are lung,breast and and bone marrow biopsies only 88305s and why are prostate biopsies and breast lumpectomies reimbursed at such a low rate ? Does the CAP have any input in the values assigned ?

I wouldn't go barking too far up that tree if I were you, because many could argue the opposite for plenty of other codes as being overbilled (GI bx's, skins, placentas, etc). Besides, after you do all the IHC and other testing that lung, breast and bone marrow almost always require you more than make up for the slightly lower reimbursement for the 88305.

 

[deleted314957]

I wouldn't go barking too far up that tree if I were you, because many could argue the opposite for plenty of other codes as being overbilled (GI bx's, skins, placentas, etc). Besides, after you do all the IHC and other testing that lung, breast and bone marrow almost always require you more than make up for the slightly lower reimbursement for the 88305.

Good point. A LONG time ago, skin was generally 88304. There are LOTS of
payor factions who have the skin 88305 in their sights. Devaluing the 88305,
as was done a couple years ago, is/was seen by many as a step in that direction.
Do not be surprised when it happens. Winter is coming.

 

[coroner]

Only the TC was cut a few years ago which hospital-based pathologists have some insulation from. Remember when everybody was predicting the demise of in-office labs when this happened? Well, somehow they've managed to survive. Incidentally, since then the PC rates per CMS actually went up. Albeit only 2%, but better than taking a loss...

 

[WEBB PINKERTON]

In-office labs survive the same way we all do....just find other crap to bill for. Payers taketh and then you figure out a way to taketh back.
With the PC rates going up a little, the cuts aren't that bad if you bill global.

If anything, the cuts have just put more pressure to consolidate on the small hospital AP operations. Doubt we see any 6 or 7 thousand accession labs much longer. Just send the specimens to the core lab of the hospital system.