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Payment_20for_202003_20Lab_20Codesstatement_091702

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									           Statement of the American Association for Clinical Chemistry
                   Centers for Medicare and Medicaid Services
        Laboratory Public Meeting: Payment New Clinical Laboratory Tests
                                 August 5, 2002

My name is Charles Root and I am here today on behalf of the American Association for
Clinical Chemistry (AACC), which represents more than 10,000 professional laboratory
scientists working in hospitals, clinical laboratories and industry. We are pleased that
CMS is continuing the process, which it started last year, to seek the advice of laboratory
and industry experts on the appropriate payment levels for the new 2003 codes. We urge
the agency to formalize this evidence-based process and make it an annual event.

After reviewing the new codes, AACC believes that all, except one, can be reasonably
compared to existing codes. Specifically, we recommend:

1.     8388x, Natriuretic peptide

       Cross-walk to 84588, Vasopressin (antidiuretic hormone) (NLA = $46.91)

       Rationale: Both natriuretic peptide and vassopressin are peptide hormones
       involved in the body’s volume, pressure and fluid regulation. Both analytes are
       typically measured by immunoassay.

2.     8430x, Sodium; other source

       Cross-walk to 84300, Sodium, urine (NLA = $6.72)

       Rationale: Same analyte, similar non-blood specimen source.

3.     8500x, Blood count; automated differential WBC count

       Cross-walk to 85027, Hemogram and platelet count, automated (NLA = $8.95)

       Rationale: An automated CBC includes an automated hemogram and platelet
       count and an automated WBC differential. Assuming that the hemogram and
       platelet count make up half of the total CBC and that the automated WBC
       differential makes up the balance, it is reasonable to assign the same value to both
       the automated differential (8500x) and automated hemogram and platelet count
       (85027).
AACC
August 5, 2002
Page Two

4.    8503x, Blood count; manual cell count (erythrocyte, leukocyte, or platelet)
      each

      Cross-walk to 85590, Platelet, manual count (NLA = $5.94)

      Rationale: Any manual cell count is similar to a platelet count.

5.    8504x, Blood count, platelet, automated

      Cross-walk to 85595, Platelet, automated count (NLA = $6.18)

      Rationale: Direct reference to existing code deleted in 2003 CPT.

6.    8538x, Fibrin degradation products, D-Dimer; ultrasensitive (eg, for
      evaluation for venous thromboembolism), qualitative or semiquantitative

      Cross-walk to 85379, Fibrin degradation products, D-Dimer; quantitative (NLA =
      $14.06)

      Rationale: Two similar D-Dimer codes are candidates. 85378, Fibrin degradation
      products, D-Dimer; qualitative or semiquantitative, and 85379, Fibrin degradation
      products, D-Dimer; quantitative. Although the new code is qualitative, the
      quantitative code is the more appropriate crosswalk since the reimbursement
      ($14.06 versus $9.86) corresponds to the added cost and value of the ultra-
      sensitive assay.

7.    8725x, Virus isolation; including identification by non-immunologic method,
      other than by cytopathic effect (e.g., virus specific enzymatic activity)

      Gap-fill, no similar code is suitable for a crosswalk.

8.    8726x, Enterovirus, direct fluorescent antibody (DFA)

      Cross-walk to 87199, Enterovirus, direct fluorescent antibody (DFA) (NLA =
      $16.58)

      Rationale: Direct reference to existing code deleted in 2003 CPT.
AACC
August 5, 2002
Page Three

9.    8727x, Cytomegalovirus, direct fluorescent antibody (DFA)

      Cross-walk to 87198, Cytomegalovirus, direct fluorescent antibody (DFA)
      (NLA = $16.58)

      Rationale: Direct reference to existing code deleted in 2003 CPT.

10.   8817x, Cytopathology, cervical or vaginal (any reporting system), collected in
      preservative fluid, automated thin layer preparation; screening by
      automated system, under physician supervision

      Cross-walk to 108% of 88142, Cytopathology, cervical or vaginal (any reporting
      system), collected in preservative fluid, automated thin layer preparation; manual
      screening under physician supervision. (NLA = $28.00 X 1.08 = $30.24)
      Rationale: Specimen collection, automated thin layer preparation and manual
      screening are priced at $28.00 for existing CPT code 88142. Conventional pap
      smears with manual screening (88150) are reimbursed at $14.60, Conventional
      pap smears with computer screening (88147) are reimbursed at $15.73 or 108% of
      manually screened Pap smears. Thus, the new code should be crosswalked to
      108% of 88142.

11.   8817x, Cytopathology, cervical or vaginal (any reporting system), collected in
      preservative fluid, automated thin layer preparation; with screening by
      automated system and manual rescreening under physician supervision

      Cross-walk to144% of 88142, Cytopathology, cervical or vaginal (any reporting
      system), collected in preservative fluid, automated thin layer preparation; manual
      screening under physician supervision (NLA = $28.00 X 1.44 = $40.32)

      Rationale: Specimen collection, automated thin layer preparation and manual
      screening are priced at $28.00 for existing CPT code 88142. Conventional Pap
      smears with manual screening and rescreening (88153) are reimbursed at $14.60,
      Conventional Pap smears with computer screening and manual rescreening
      (88148) are reimbursed at $21.00 or 144% of manually screened and rescreened
      paps. Thus, the new code should be crosswalked to 144% of 88142.
AACC
August 5, 2002
Page Four

12.    8905x, Leukocyte count, fecal

       Cross-walk to 87205, Smear, primary source with interpretation; Gram or Giemsa
       stain for bacteria, fungi, or cell types. (NLA = $5.90)

       Rationale: Since this procedure is done as a smear, 87205 represents the most
       similar existing code.

I would be happy to answer any questions you may have regarding our recommendations.
Thank you for your consideration in this matter.

								
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