One learns a few pathology billing codes in residency/fellowship but truth be told many academic medical centers concerns themselves more with sheer volume rather than particular codes such as 88305, 88307, 88309, 88311, 88312 and 88342. More patients equal more tests and procedures equals more biopsies and more surgeries equals more specimens and billable biopsies, surgicals, special stains, flow, immunohistochemistry, etc…
Earlier this year of course 52% reductions in reimbursement for technical component of 88305 went into effect. With the announcement last Wednesday of additional cuts, to bottom line it, immunohistochemistry, or the very commonly used 88342 code is no more per The Pathology Blawg. Both the technical and professional were hit hard, the professional particularly hard (designated with a -26 modifier) on this new (at least to me) G-code system.
Successful labs and laboratory operations know to the cent their cost per test, cost per slide, cost per biopsy or cost per surgical.
We make slides. Let’s call them widgets. When you make widgets and sell widgets, in effect, one likely knows how much it costs to make a widget. That is to include, but not limited to, cost of raw materials, transportation of raw materials, production of widget, insurance, rent, taxes, utilities, payroll, depreciation on widget making machines, repairs on widget making machines and so forth.
Successful histology operations know how much per test and in some cases, per FTE, what their costs are.
That being said, most histology operations I gather do not know how much it costs per widget or per FTE to make their widgets (slides). They know what Medicare and other insurers are likely to pay with appropriate claims and medical necessity for such widgets and widget reads.
Nonetheless, CMS just appears to be going after some of the high volume codes in use without regard to what the tests actually costs or is worth. Anything beyond the first immunohistochemical stain on a case will pay $12.48 a read, down 70% from 2013 levels. The technical component reimbursements are down over 20%. In fact, the 88342 is history, being replaced by this new G-code system on a tiered system. Read more at The Pathology Blawg.
What does this mean for your laboratory, your hospital laboratories and your business?