From the President’s Desk: Now and Future Policy Agenda

Create PDF

The CAP led a multi-stakeholder effort to develop CPT codes for the physician fee schedule to cover molecular services, but in November, the CMS—citing differences of opinion within the stakeholder community—announced that 101 new CPT codes for billing of molecular services would be placed on the Medicare clinical laboratory fee schedule. The good news is that the CMS did provide an interim G code for physician work performed in connection with these tests. Jonathan Myles, MD, who chairs the CAP Economic Affairs Committee and advocates for pathology before the RUC, says the CMS’ willingness to do so shows that it recognizes the important professional role of pathologists in molecular diagnostics and that physician interpretation of these tests is medically necessary under certain conditions.

The CMS will monitor billing with the G code and use the gap-filling method to reimburse tier 1 and tier 2 molecular services listed on the clinical lab fee schedule. For the balance of 2013, it will be important for pathologists to use the G code to bill for the professional component of molecular services. To use the G code, the pathologist must ensure that the interpretation is requested by the patient’s attending physician, results in a written narrative report included in the patient’s medical record, and requires the exercise of medical judgment by the consultant physician. (The hospital’s standing order policy can be used as a substitute for the individual request by a patient’s attending physician.)

Pathologists who attended the May 6–8 CAP Policy Meeting had more than 100 personal meetings with members of Congress and their staff, a new record for this annual meeting. For 70 of the attendees, this was a first visit to the Hill. As Kathryn T. Knight, MD, who chairs the CAP Federal and State Affairs Committee, likes to say, personal advocacy for our profession, whether in Washington or at the state or local level, may be a bit intimidating initially but then quickly becomes addictive. It certainly helps us get things done. Over the years many of us have built close friendships with our legislators.

Two days of education enabled Policy Meeting participants to present the CAP Now and Future Policy Agenda, which highlights immediate and long-term health systems issues. Among other things, pathologists and policymakers discussed the importance of fair payment for pathologists, the value of pathologists in ACOs, the promise of properly managed genomic medicine services, the need for sufficient graduate medical education funding, the vital role of properly structured and managed health information systems, and the rationale for eliminating the in-office ancillary services exception.

As the meeting wrapped up and pathologists returning from the Hill were debriefed, the room buzzed with energy. Standing there, I recognized the effective democracy that my father had sought, a model for the citizen engagement with which we will continue to give shape to our hopes.

Dr. Robboy welcomes communication from CAP members. Send your letters to him at president@cap.org.