DNA and RNA based testing has one big problem for labs: A lack of reimbursement
There is an urgent need to improve coding knowledge and reduce industry-wide confusion for CPT coding of DNA and RNA based test procedures. This isn't new, these tests are complicated, and the coding guidelines are limited. Due to COVID-19, this type of testing has been pushed into the spotlight, highlighting existing problem areas and magnifying the need for education.
For COVID-19 specifically, multiple code options exist, and labs are struggling when determining which to use. The new HCPCS codes? The new CPT code? Previously existing respiratory viral panel codes? PLA codes?
However, selecting the correct code for COVID-19 testing is just a piece of the puzzle for laboratories, and the questions behind the logic for these code selections mirror other testing being done.
Looking beyond COVID-19, the problems are much larger. Lack of reimbursement for DNA and RNA based testing procedures is a common problem for labs across the country due to denials and payer recoupment following post-payment audits. With payers auditing claims dating back to 2014 – applying guidelines that were not published until 2019 – coupled with codes, guidelines, and payer policies that haven't kept up with advancements in technology, labs end up facing a difficult situation where they have no accurate option for CPT code assignment.
What do you do when your only options are stacking codes or submitting an unlisted code? Are you confident with CPT code selections for DNA and RNA based testing? Are you sure your practices are fully compliant with coding and payer guidelines?
This session, presented by leading laboratory coding expert Robin Zweifel, will consolidate the information you need to ensure confidence in your workflows and code selections for DNA and RNA based tests. Not only will she address the common questions related specifically to coding for COVID-19 testing, she will also address the larger issues at hand, helping you walk away confident in your overall coding and compliance for these tests.
- Strategies for accurate, successful CPT code selections – including COVID-19 testing
- Best practices for determining selection of Tier1/Tier 2, GSP, MAAA, PLA, and other Category I CPT codes
- When unlisted CPT code 81479 should be reported – and the complications of reporting an unlisted code
- Understand the technical terminology that impacts CPT code selection
- Interpretation of payer coverage and medical necessity policies
- The impacts of the 2019 and 2020 NCCI policy updates
- How to apply this information for correct coding and billing of DNA and RNA based testing
- How COVID-19 is impacting payments for rapid respiratory viral pathogen panels
- Review of the date of service rules for ADLTs
- Time permitting, answers to attendee questions (live event only)
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