TAG:
cpt code
Medicare Carrier Proposes No Pay for Vitamin D Test
CEO SUMMARY: Medicare contractor NGS wants to end payment to labs and physicians for routine Vitamin D testing. In a proposed local coverage determination (LCD), the Medicare carrier says it would cover Vitamin D testing only for patients with chronic kidney disease, osteomalacia…
Illinois Pathologists Dodge Medicaid CP Payment Cut
CEO SUMMARY: Pathologists in Illinois acted swiftly to this month’s announcement that the Illinois Medicaid program would cease to directly pay pathologists directly for clinical pathology professional services. The new policy was to take effect on October 1, 2008. As t…
Implementation Date For ICD-10 Is Proposed
CEO SUMMARY: Even though the transition from ICD-9 to ICD-10 will not be required until 2011, laboratories and pathology groups should have a transition plan in place. ICD-10’s 155,000 seven-digit codes will replace the 17,000 five-digit codes of ICD-9. Because of major…
Numerous Issues Identified With Bid Demo’s 303 Tests
CEO SUMMARY: One experienced expert in billing and coding was surprised at the list of 303 tests to be included in the Medicare Laboratory Competitive Bidding Demonstration Project. He notes that the list of 303 tests includes a number of codes and descriptions that are not consistent wit…
Federal Whistleblower Suit Settled by Dianon Systems
IT’S A REMINDER THAT WHISTLEBLOWERS continue to look for opportunities to turn in laboratories, even if the violations are relatively minor. Last month, Dianon Systems Inc., of Stratford, Connecticut, agreed to pay $1.5 million to settle a federal false claims action originally fi…
An Economic Perspective On Discounted PC Deals
CEO SUMMARY: By opening their own in-office pathology laboratories, specialist physicians are undermining a long-established referral relationship with the pathology profession. Pathologists are debating the merits of this market-based trend and its effect on their profession. However thi…
Michigan Derm Convicted On 31 Fraud Charges
CEO SUMMARY: Last year, dermatologist Robert W. Stokes, D.O., of Grand Rapids, Michigan, was indicted by the federal government for 72 counts relating to various offenses, including upcoding, and improper coding. Of this total, 35 counts against Stokes involved his billing payers for labo…
Sonic Healthcare & CPL Make First Acquisition
CEO SUMMARY: Expanding from its base in Texas, Clinical Pathology Laboratories, Inc. (CPL) has acquired Cognoscenti Health Institute, LLC of Orlando, Florida. The deal was done discreetly and gives Sonic Healthcare, Ltd., parent of CPL, a solid foothold in Florida. Cognoscenti has also ma…
Lab MUEs Reconsidered, CMS Changes Course
CEOSUMMARY: It may bear are moment of common sense. Last month, Medicare officials stated their intent to exclude clinical laboratory and anatomic pathology CPT codes from the “Phase One” implementation of Medically Unbelievable Edits (MUEs). It is a positive step, and comes in respon…
CMS Defers MUE Edits Until After Jan. 1, 2007
CEO SUMMARY: Medicare officials have granted a temporary respite on the troubling proposal to institute service restrictions per patient on some 80 pathology CPT codes and 1,100 clinical laboratory codes. These proposals are part of a new round of Medically Unbelievable Edits (MUEs). CMS …
CURRENT ISSUE
Volume XXXII, No. 6 – April 21, 2025
Now that a federal judge has vacated the FDA’s LDT rule, The Dark Report analyzes the judgement and notes the various steps the FDA could take in response. Also, lab testing at pharmacies is proving to be less successful than was once anticipated.
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