G0452, the hidden gem of the 2021 fee schedule.

[LADoc00]

Step 1.) Create standing policy all molecular reports are to be re-reviewed by a pathologist
Step 2.) Create report summarizing said report
Step 3.) Bill G0452
Step 4.) Collect $43 bucks per. The only code which is up +124%

Almost every cancer case is getting NGS performed now...

thoughts?

Also, what about an SDN practice where we send cases around for 88325s? $154 per.

We have to start thinking outside the box or die.

Also,

If you ditch your cytotech, each pap smear is billed as a P3001 AND 88141, which is $42 per. At 80 per day is $3360 per day. Then you put all 80 with HPV testing (codes dont seem to be on the actual fee schedule tho) AND then G0452'd them....Is there something there?

Is there a "Beautiful Mind meets Good Will Hunting" type out there that can look at the fee schedule and make something of it?

Im doing a little Beautiful Mind thing on my own...had a conversation with a large commercial lab that is partnering with local path groups to put in NGS testing, you do a reagent rental agreement, do NGS, bill for that and wrap it in a G0452. I would have never thought of going this angle until I saw the G0452. Taking specimens from a hospital and sending it to lab you own is literally baked into pathology culture but is anyone actually do this???

I would assume what the commercial labs doing this are in it for is the data mining and selling it biopharma.

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[WEBB PINKERTON]

Better off starting a tree cutting business. My tree cutting business makes more than 3 grand a day.

 

[gbwillner]

Step 1.) Create standing policy all molecular reports are to be re-reviewed by a pathologist
Step 2.) Create report summarizing said report
Step 3.) Bill G0452
Step 4.) Collect $43 bucks per. The only code which is up +124%

Almost every cancer case is getting NGS performed now...

thoughts?

Also, what about an SDN practice where we send cases around for 88325s? $154 per.

We have to start thinking outside the box or die.

Also,

If you ditch your cytotech, each pap smear is billed as a P3001 AND 88141, which is $42 per. At 80 per day is $3360 per day. Then you put all 80 with HPV testing (codes dont seem to be on the actual fee schedule tho) AND then G0452'd them....Is there something there?

Is there a "Beautiful Mind meets Good Will Hunting" type out there that can look at the fee schedule and make something of it?

Im doing a little Beautiful Mind thing on my own...had a conversation with a large commercial lab that is partnering with local path groups to put in NGS testing, you do a reagent rental agreement, do NGS, bill for that and wrap it in a G0452. I would have never thought of going this angle until I saw the G0452. Taking specimens from a hospital and sending it to lab you own is literally baked into pathology culture but is anyone actually do this???

I would assume what the commercial labs doing this are in it for is the data mining and selling it biopharma.

It's nice that the G0452 code was upgraded from hot garbage to less-than'hot-garbage. Interpreting complex NGS cases can take up to 3 hrs (there are a lot of factors at play here), particularly if you are only working with VUS.
I bill 88325 BUT require that the ordering clinician "order" my professional interpretation Consultation on the Req form, AND they have to submit oncology notes for my review. If notes are not provided then I bill 88323, assuming I need to cut slides. If no consult is ordered THEN I bill G0452.

Unless you have real SME in this field there is no point in having a pathologist review these cases. You are not interpreting the Dx of cancer; if you are billing 88325 you will be telling the oncologist which drug to treat with and why, or which to avoid (based on the genetic findings). You will be expected to explain the shortcomings of the assay if when when relevant (hint- a lot of the time). You are also expected to identify the most relevant clinical trials for the patient based on your experience.

 

[LADoc00]

GB...why are we not standing up NGS labs???? This is no a brainer.

 

[LADoc00]

Better off starting a tree cutting business. My tree cutting business makes more than 3 grand a day.

Hold it what? Nice. Random but nice. I thought about doing QC testing for illicit drugs which I guess it legal in CA but tree cutting seems a lot easier

 

[LADoc00]

Anyone have a good "How to get a NGS lab going" guide other than: https://www.aphl.org/aboutAPHL/publications/Documents/ID-NGS-Implementation-Guide102016.pdf

 

[LADoc00]

It's nice that the G0452 code was upgraded from hot garbage to less-than'hot-garbage. Interpreting complex NGS cases can take up to 3 hrs (there are a lot of factors at play here), particularly if you are only working with VUS.
I bill 88325 BUT require that the ordering clinician "order" my professional interpretation Consultation on the Req form, AND they have to submit oncology notes for my review. If notes are not provided then I bill 88323, assuming I need to cut slides. If no consult is ordered THEN I bill G0452.

Unless you have real SME in this field there is no point in having a pathologist review these cases. You are not interpreting the Dx of cancer; if you are billing 88325 you will be telling the oncologist which drug to treat with and why, or which to avoid (based on the genetic findings). You will be expected to explain the shortcomings of the assay if when when relevant (hint- a lot of the time). You are also expected to identify the most relevant clinical trials for the patient based on your experience.

GB I respect your opinion so why are you burning ANY daylight on VUS? Which for the uniformed is variants of UNCERTAIN significance. How can this take 3hrs and be reimbursed only 42 bucks?!

What is the "standard" for a G0452 report??

 

[gbwillner]

GB I respect your opinion so why are you burning ANY daylight on VUS? Which for the uniformed is variants of UNCERTAIN significance. How can this take 3hrs and be reimbursed only 42 bucks?!

What is the "standard" for a G0452 report??

It depends on what the oncologist is looking for when they submit the request. If the patient has a lung adenocarcinoma but is EGFR negative, does not have high TMB, and 25 assorted VUS mutations that may be activating in targetable genes, and the oncologist is asking what trials are most relevant or if the patient could benefit from off-label targeted therapies, you will have to investigate VUSs. This is not always relevant, but when you offer this kind of insight you tend to get these kinds of requests.

 

[AZpath]

https://webapps.cap.org/apps/docs/reference/molecular_pathology_hcpcs_g_code.pdf

Looks like it needs an physician order

 

[LADoc00]

It depends on what the oncologist is looking for when they submit the request. If the patient has a lung adenocarcinoma but is EGFR negative, does not have high TMB, and 25 assorted VUS mutations that may be activating in targetable genes, and the oncologist is asking what trials are most relevant or if the patient could benefit from off-label targeted therapies, you will have to investigate VUSs. This is not always relevant, but when you offer this kind of insight you tend to get these kinds of requests.

Dear lord we cant catch a break.

 

[deleted314957]

https://webapps.cap.org/apps/docs/reference/molecular_pathology_hcpcs_g_code.pdf

Looks like it needs an physician order

Yep, we’ve been thru this crap with clin path. Remember, had to have a physicians order for the clinpath codes for enzyme interp, etc. The , the STANDING order of the medical staff didn’t cut it. Had to have individual doctor to doctor consults with requests in the charts, on it went....

 

[NTerminus]

It's nice that the G0452 code was upgraded from hot garbage to less-than'hot-garbage. Interpreting complex NGS cases can take up to 3 hrs (there are a lot of factors at play here), particularly if you are only working with VUS.
I bill 88325 BUT require that the ordering clinician "order" my professional interpretation Consultation on the Req form, AND they have to submit oncology notes for my review. If notes are not provided then I bill 88323, assuming I need to cut slides. If no consult is ordered THEN I bill G0452.

Unless you have real SME in this field there is no point in having a pathologist review these cases. You are not interpreting the Dx of cancer; if you are billing 88325 you will be telling the oncologist which drug to treat with and why, or which to avoid (based on the genetic findings). You will be expected to explain the shortcomings of the assay if when when relevant (hint- a lot of the time). You are also expected to identify the most relevant clinical trials for the patient based on your experience.

This may not be the best thread for this question, but I am wondering if it is possible to sign out NGS reports without MGP fellowship training? I am a neuropathologist in training with a strong interest in neuro-oncology, and make sure to stay updated on genetic alterations in CNS neoplasms. I am just curious if on the job training or some dedicated coursework in my free time might be sufficient to interpret and integrate NGS data into my own neuro reports.

 

[Spikebd]

This may not be the best thread for this question, but I am wondering if it is possible to sign out NGS reports without MGP fellowship training? I am a neuropathologist in training with a strong interest in neuro-oncology, and make sure to stay updated on genetic alterations in CNS neoplasms. I am just curious if on the job training or some dedicated coursework in my free time might be sufficient to interpret and integrate NGS data into my own neuro reports.

I would think this is a reasonable pursuit.

 

[LADoc00]

This may not be the best thread for this question, but I am wondering if it is possible to sign out NGS reports without MGP fellowship training? I am a neuropathologist in training with a strong interest in neuro-oncology, and make sure to stay updated on genetic alterations in CNS neoplasms. I am just curious if on the job training or some dedicated coursework in my free time might be sufficient to interpret and integrate NGS data into my own neuro reports.

Yes. MGP fellowships havent even been a thing until recently.