2023 Laboratory Coding Update

New CPT®/HCPCS codes including revised and new CPT codes for separate reporting of RNA or DNA analysis for somatic cancers (solid organ or hematolymphoid neoplasm or disorder) go into effect Jan 1, 2023. Continuing into the new year will be the trend of new, revised and deleted PLA codes across the spectrum of laboratory services. Changes to prior authorization, DEX code requirements and more for multi-gene NGS panels will also impact clinical laboratories. Labs need to be aware of payer policy updates that bundle payments to a single CPT and further impact downward-trending payments. Add to that, payer pre-payment audits to verify the presence of physician orders – are payers accurately applying CMS rules for physician signatures? All of these changes and trends, along with several others, mean another high-risk year for clinical laboratories. But you can reduce the threats to your compliance and revenue by tapping into the expertise and clear, steady guidance of Robin Zweifel in this annual webcast.

Robin packs a lot of valuable how-to information into 90 minutes: in-depth interpretation, insights, and instruction pertaining to 2023 coding, payment and policy changes, as well as guidance through some of the most challenging areas for laboratories, such as medical necessity issues, documentation to support genetic testing and correct billing based on date-of-service exceptions. You can trust that Robin will deliver the latest guidance for correct reporting. It’s never been more important to make certain you’re coding and billing compliantly, and we’ll help you get there by breaking down the challenges through clear, practical instruction.

Webcast Takeaways

• Guidance through all the 2023 coding changes impacting laboratory services
• Payment changes for 2023, encompassing both the Clinical Laboratory Fee Schedule (CLFS) and Outpatient Prospective Payment System (OPPS), and their impact on laboratories
• Review of PAMA with a look at Saving Access to Laboratory Services Act (SALSA) with discussion of whether Congress will provide relief from laboratory reimbursement cuts for 2023 and beyond
• Special help with areas of concern, confusion, noncompliance and missed revenue opportunities, including:
  • CPT coding guidelines for clinical pathology interpretations, drug-of-abuse testing, chemistry, hematology, urinalysis, immunology, microbiology, and molecular pathology
  • The compliance risks of stacking codes for multi-gene NGS panels
  • Interpretation of payer policy changes that impact coding and billing guidelines for detection of infectious agents
  • Comparison of 2009-2011 audits of Toxicology Labs to current-day pre-payment reviews for medical necessity of confirmation testing / definitive analysis
  • Successfully decipher the guidance for choosing an MAAA, PLA or Category I CPT code
  • Strategies for protecting revenue integrity in the face of many threats
• Recovery audit contractor (RAC) targets, including the documentation requirements to support billing of multi-gene NGS panels
• Detailed instruction for detecting and fixing documentation weaknesses that can lead to payment denials; includes the critical difference between “medical necessity” and “medically indicated”
• Time permitting, answers to attendee questions

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