Urine FISH

[musom]

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Anyone performing TC in-house? I'm considering bringing it in-house and was hoping for some insight to that process.

 

[Pathbusiness]

What is your annual volume?

 

[musom]

In 2017 I did 256 urine cytology cases. I expect that to be closer to 700-800/year once the local urology group signs on.

When should FISH be reflexed? Any "atypical urothelial cells" dx? I'm considering the 4 probe Urovysion.

 

[Pathbusiness]

It is mostly dual, reflex. or cytology only on the requisition. The referring Urologist checks the option. Your volume is very small for TC though.

 

[musom]

Can anyone that does PC and or TC/PC for urine FISH (Urovysion specifically) chime in on CPT codes used for each? Having trouble seeing if it is cost effective to bring in-house still. Thanks in advance.

 

[musom]

I guess I'm more interested in TC, as I believe 88120 and 88121 are the CPT codes, and I can calculate my reimbursement on the PC side quite easily.

 

[LADoc00]

The run cycle on this is supposedly huge, you really need a machine completely dedicated to it as the cycle is like 18 hrs per run. This makes the minimum annual volume requirement for ROI way way high although to be honest I havent looked at this in like 6-7 years. But I know the run cycle is still epic, I had Roche in my office last week saying nothing has changed and due to the laws of thermodynamics, they dont expect this cycle time to come down.

 

[musom]

Makes sense. One of the reps just very generically told me that if I did a run a week (about 5-6 cases) that it would be cost effective to bring it in. I may have enough volume to get 5-6 atypicals or bladder CA f/u's a week to do a run. But then again, maybe I'll just virtual PC it and be done. I wouldn't collected on the TC anyway....

 

[AZpath]

The TC payment is pretty large on 88120-88121. 588.00 and 488.00. That seems pretty juicy
The PC is 60 and 50 bucks. The lower fees are for computer assist( 88121). So what is needed in terms of equipment, materials and people for manual verses auto?

 

[musom]

Well up front costs include a florescence scope with four filters, (sprectrum red/green dualband, yellow single band, aqua single band and DAPI). I currently have a Olympus BX43 florescence scope with DAPI so that helps on the upfront costs. The filters are around $1500 each give or take. You also need the slide hybridizer (Thermobrite is the Abbott unit) which is $6000 new and much (much) less expensive on the gently used side. I was quoted a cost per test of about $110, which I would assume that's when you would have a full run (12? slides/run I think). The have an automated system "pick-up dunk, set, pick-up dunk repeat", but the rep said most small labs can perform all of that in coplin jars.

I'd be doing the manual interpretation, as I think trying to figure out the "computer assisted interpretation" myself would add to the overall complexity of setting this up? If I was going do the computer assisted interpretation, I'd PC this and have the TC sent out, which may be my best option anyway.

 

[musom]

The TC payment is pretty large on 88120-88121. 588.00 and 488.00. That seems pretty juicy
The PC is 60 and 50 bucks. The lower fees are for computer assist( 88121). So what is needed in terms of equipment, materials and people for manual verses auto?[

I don't understand this and maybe someone else might...but our corporately quoted reimbursement rates for TC on 88120 is $120 and $200 on 88121. What you quoted AZpath ($588/$488) is very similar to the quote by the rep, but a huge discrepancy with that corporate Medicare rate??????

 

[AZpath]

http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution Folders/WebContent/pdf/cap-2019-proposed-Medicare-impact-table.pdf

Here is this year fees and next year proposed fees.

 

[27G]

Former Owner of Bostwick Laboratories Agrees to Pay Up to $3.75 Million to Resolve Allegations of Unnecessary Testing and Illegal Remuneration to Physicians

 

[27G]

A prospective comparison of UroVysion FISH and urine cytology in bladder cancer detection