AMA Releases Molecular Pathology CPT Codes for Stakeholder Review
March 11—The American Medical Association (AMA) is releasing for comment two sets of proposed CPT codes covering over 90% of the volume of current molecular pathology procedures. The CAP’s Advocacy Office in Washington, DC is notifying both Statline and CAP Today readers in this special e-Alert, as the AMA is seeking broad stakeholder input on these codes (see box to submit comments online).
This new proposed code set represents the biggest change in pathology and laboratory CPT coding in the last 20 years, explained CAP member Mark Synovec, MD, who is co-chair of the AMA Molecular Pathology Coding Workgroup (MPWG). The workgroup was convened by the AMA CPT Editorial Panel in December 2009 to address issues for coding molecular assays in cancer, genetics, and histocompatibility. “Our goal is to have a specific CPT code for a large majority of the clinically useful molecular pathology procedures performed,” he added.
Submitting Code Comments
Feedback should be submitted through the AMA Website
. Comments are due by April 15, 2011.
Any questions should be sent to AMA staff by April 15 at email@example.com
The release of these codes for stakeholder feedback marks a departure from how AMA traditionally conducts the coding review process. “To have these codes open for review at this stage is really unprecedented, but is indicative of a more open CPT system,” said Dr. Synovec. The AMA plans to ultimately publish these codes in the CPT 2012 code set.
It is important to note that these codes and descriptors are not yet available for reporting and not yet recognized by payors. Furthermore, inclusion of an analyte in this CPT code set does not imply any health insurance coverage or reimbursement policy. While these descriptors describe a service, payment policy will determine appropriate payment for these services, according to the AMA document accompanying the feedback request.
There are two categories of codes: Tier 1 and Tier 2. Tier 1 includes the most commonly-performed services; each will have an analyte specific CPT code. The less common services are categorized in Tier 2. These services have been assigned to nine resource level codes determined by level of resources required for their performance and interpretation.
For tests not considered Tier 1 or Tier 2, the current coding method—using “stacking codes” (83890-83914)—will apply for 2012. Moving forward, these stacking codes will be retired at the conclusion of the MPWG work.
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