Clinical Pathology Consults -

[Atreus21]

What do you think guys think of the need for CP docs to perform interpretations and billing with the 80502 CPT code? Apparently, this process can be streamlined with software by mining the LIS and EMR. Given the speed and the billing, it could be an interest niche.

In a simliar vein there was an interesting article from a health system in TX, where the CP docs act as a bridge between PCP and Rheum.

Algorithmic Approach With Clinical Pathology Consultation Improves Access to Specialty Care for Patients With Systemic Lupus Erythematosus

Thoughts?

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[Napoleon1801]

I would be initially cautious with it, as you would probably need to have a thumbs up from your med exec committee to make it an automatic reflex. If you could get your Rheum specialists to endorse the process, it could make sense. Unsure how well it might reimburse though.

From CAP Q&A: http://www.captodayonline.com/Archives/feature_stories/0405CPTqa.html

Q: With codes 80500 and 80502, are we allowed to use a hospital standing order to comply with the Medicare requirement that the patient’s attending physician should request the clinical consultation?

A. Standing orders in the medical record do not satisfy the attending physician request requirement for clinical pathology consultation services reported with 80500, Clinical pathology consultation; limited, without review of patient’s history and medical records, or 80502, Clinical pathology consultation; comprehensive, for a complex diagnostic problem, with review of patient’s history and medical records, according to the Centers for Medicare and Medicaid Services.

Clinical consultations are payable under the Medicare Part B physician fee schedule only if they are requested by the patient’s attending physician; relate to a test result that lies outside the clinically significant normal or expected range in view of the condition of the patient; result in a written narrative report included in the patient’s medical record; and require that the consultant physician exercise medical judgment.

 

[Atreus21]

I would be initially cautious with it, as you would probably need to have a thumbs up from your med exec committee to make it an automatic reflex. If you could get your Rheum specialists to endorse the process, it could make sense. Unsure how well it might reimburse though.

From CAP Q&A: http://www.captodayonline.com/Archives/feature_stories/0405CPTqa.html

Q: With codes 80500 and 80502, are we allowed to use a hospital standing order to comply with the Medicare requirement that the patient’s attending physician should request the clinical consultation?

A. Standing orders in the medical record do not satisfy the attending physician request requirement for clinical pathology consultation services reported with 80500, Clinical pathology consultation; limited, without review of patient’s history and medical records, or 80502, Clinical pathology consultation; comprehensive, for a complex diagnostic problem, with review of patient’s history and medical records, according to the Centers for Medicare and Medicaid Services.

Clinical consultations are payable under the Medicare Part B physician fee schedule only if they are requested by the patient’s attending physician; relate to a test result that lies outside the clinically significant normal or expected range in view of the condition of the patient; result in a written narrative report included in the patient’s medical record; and require that the consultant physician exercise medical judgment.

Yes, that is true. In order to get reimbursed you need a physician to request the order. However, it could set up as a consult. I believe that was the pilot in this paper. The PCP would place an order, something like "Rheumatology triage". I could see this working for other areas like Endocrinology or work up anemia.

Funny enough I just saw a notice from CAP Today about the DMT conference and found this session:

I know Dr. Laposata says the reimbursement shouldn't matter (because of the downstream cost savings to the health system), however if you can paid for a professional interpretation, why not? And it will incentivize pathologists.

Apparently medical malpractice carriers are interested in this to reduce diagnostic error, however CMS and private payers will probably need more data.

 

[Napoleon1801]

Getting paid is great, but also concerned about how much time it would take to generate a narrative consult. Is it worth the time?

 

[AZpath]

Getting paid is great, but also concerned about how much time it would take to generate a narrative consult. Is it worth the time?

You would have to set up the system so all the clinical and lab info comes to you once a consult is ordered. The narrative would normally be a canned statement with a few variables .
The narrative is not likely the hard part. If you do just a few a year it would be a pain.

This does get me thinking.
We review a lot of abnormal blood smears in the hospital and from the ER.
I am sure there are a lot of cases of CLL, MDS etc that get missed.

Having a clinical consult that tell them what more they can do might help.

 

[LADoc00]

Hmm I looked at this thread and saw DMT in bold and thought maybe someone was going full "Joe Rogan"...sadly no. I have nothing to contribute here sorry.

 

[Atreus21]

Getting paid is great, but also concerned about how much time it would take to generate a narrative consult. Is it worth the time?

It is not worth the time in the current state, however software can make it possible. There are a few companies working on it. If you can easily pull the relevant data out of the EMR and labs from the LIS, you can easily get to a report writer that can be signed out. It may be especially helpful for PA's and NP's.

 

[AZpath]

It is not worth the time in the current state, however software can make it possible. There are a few companies working on it. If you can easily pull the relevant data out of the EMR and labs from the LIS, you can easily get to a report writer that can be signed out. It may be especially helpful for PA's and NP's.

It depends on your lab. I could easily review the labs and EMR from our hospital.

 

[deleted314957]

books were written back in the 80’s post tefra on how to mine the gold from the lab with clinical consults. they had one book ( i got it) that had a BASIC computer
program designed for the IBM PC running an 8088 processor as i used at the time.
64k ram and dual 5 1/4” floppies!
the whole idea of how to get more money out of the clinical lab is very, very old.
pre tefra most money was in the lab and we tended to give away the surg path.
that changed suddenly. and we were then stuck with our artificially low AP fees.