Billing for synoptic reporting

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levels x3

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Anybody doing this? We are not as of today, but have heard it is possible specifically for breast and colon cancer if you use a synoptic report for at least 70% of these cases. We use the CAP templates for essentially 100% of these cases. After a quick search on the CAP website, I was unable to turn up any information about billing for using these templates. Anybody have any information?
 
levels x3 said:
Anybody doing this? We are not as of today, but have heard it is possible specifically for breast and colon cancer if you use a synoptic report for at least 70% of these cases. We use the CAP templates for essentially 100% of these cases. After a quick search on the CAP website, I was unable to turn up any information about billing for using these templates. Anybody have any information?
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Medicare gives a 1% or 0.5% bonus or something like that if you use the CAP summaries breast and colon resections. The code is 3260F. I don't know if private insurance acknowledges it. I doubt they do.
 
pathstudent said:
Medicare gives a 1% or 0.5% bonus or something like that if you use the CAP summaries breast and colon resections. The code is 3260F. I don't know if private insurance acknowledges it. I doubt they do.
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Oh and a code of 3260-1P (cancer case summary not done - no residual cancer) is given if there is no residual CA and a code of 3250F (cancer case summary not done - not primary site) you don't do a cancer case summar because it is not the primary site. I don't know if the bonus you out for those codes but my guess would be not.
 
pathstudent said:
Oh and a code of 3260-1P (cancer case summary not done - no residual cancer) is given if there is no residual CA and a code of 3250F (cancer case summary not done - not primary site) you don't do a cancer case summar because it is not the primary site. I don't know if the bonus you out for those codes but my guess would be not.
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Oh and you have to hit 80%. Not 70%. And this was for 2009. Not sure if medicare is still bonusing you out in 2010.

http://www.cap.org/apps/cap.portaL?..._PQRI.html&_state=maximized&_pageLabel=cntvwr
 
Yeah, the bonuses still exist in 2010. Googling the cpt code you posted earlier got me to the CMS website for this. It's all part of the Physician Quality Reporting Initiative (PQRI). It has nothing to do with private insurance as far as I can tell. It is essentially a pay for performance program to incentivize the use of adequate staging information (e.g. TNM staging). Basically, if you participate and meet the reporting requirements on 80% of your cases in a given year (breast and colon cancer), as indicated by the use of these codes, CMS will give you a bonus equal to 2.0% of your total medicare part B billing for that year. That's total part B billing, not just for those specific cases and so can add up to real money.
 
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