Artemis Press Release

 https://artemisdna.com/artemis-dna-to-close-houston-texas-facility/

DOJ Websites, Genetics and Telemedicine

 Case sites Amerihealth lab (in Part B database) and MP3 labs.

https://www.justice.gov/criminal-fraud/file/1521161/download

Case sites to ELITE labs, in 2020 Part B database; etc.

https://www.justice.gov/criminal-fraud/file/1520911/download

Umbrella press release, includes further information links at bottom

https://www.justice.gov/opa/pr/justice-department-charges-dozens-12-billion-health-care-fraud

Web page of court documents, many telemed cases involve genetics.

https://www.justice.gov/criminal-fraud/telemedicine-court-documents

81408 by STATE

ARTEMIS lab, CMS Part B 2020 data

 

PLA Codes 2020

 

AMA Tumor Workgroup August 18 2022

 https://www.ama-assn.org/about/cpt-editorial-panel/cpt-workgroups

Tumor genomics testing workgroup

This workgroup aims to create CPT coding solution(s) for extended/comprehensive genomic testing in tumor/neoplastic conditions, including whole genome sequencing. In the deliberation process, the workgroup will utilize information gained in the AMA’s July 2021 Diagnostic Precision Medicine Coding and Payment meeting to determine the feasibility of more granular coding solutions within this space. If deemed appropriate the workgroup may additionally suggest a more granular coding solution for non-neoplastic genomics testing.

Our next workgroup call will be held on Aug. 18, 2022, from 5-6:30p.m. Central. Register now on Zoom.

Each public call will allow for time at the end for stakeholder comments. We cannot guarantee that everyone will have time to speak during these open comment sections, but it is our intent to hear from all sides. Also, given the nature of the discussion, attendees will need to sign an AMA CPT Confidentiality form. DocuSign forms will be sent to attendees prior to the meeting. Attendees must fill out the forms prior to attending, otherwise they will not be allowed to join the call.

Unlisted Codes and ASC, APC (or DRG)

 

Glaukos (GKOS): Headwinds vs. Tailwinds

John Leppard, 202-756-7703 jleppard@washingtonanalysis.com

A potentially overlooked headwind in the recent billing article update by Medicare Administrative Contractor (MAC) Palmetto, implying that Glaukos’ (GKOS) iStent should not be used with its new iAccess microgoniotomy product, is its concurrent instruction that, “since there is no specific CPT code for goniopuncture, or so-called microgoniotomy procedures, the unlisted CPT code 66999 should be reported in these instances.” As an unlisted procedure code, CPT 66999 is currently excluded from Medicare payments in ASCs, no MACs list a corresponding professional fee amount for its use, and ~99% of such claims [N = 5,052] were denied in the most recently available claims year (CY20). While other MACs have not yet followed Palmetto’s lead to such an explicit extent [see Novitas & First Coast below], documentation requirements, independent coding reviews [June 22, April 19], and provider uncertainty suggest that iAccess volumes – whether standalone or in combination with iStent – may be limited until there is greater clinical data on appropriate patient populations. As outlined in our July 14 note, however, we remain bullish on coverage / reimbursement for the recently approved iStent Infinite and the launch of iDose (mid-CY23).

Medicare Defines Diagnostic

 https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c06.pdf

20.4.1 Diagnostic Service Defined

20.4.1 - Diagnostic Services Defined (Rev. 82; Issued: 02-08-08; Effective: 01-01-08; Implementation: 03-10-08) 

A service is “diagnostic” if it is an examination or procedure to which the patient is subjected, or which is performed on materials derived from a hospital outpatient, to obtain information to aid in the assessment of a medical condition or the identification of a disease. Among these examinations and tests are diagnostic laboratory services such as hematology and chemistry, diagnostic x-rays, isotope studies, EKGs, pulmonary function studies, thyroid function tests, psychological tests, and other tests given to determine the nature and severity of an ailment or injury.

410.2 PREV defined   42 cfr 410.2   - defined only by examples list, not by theory.

Could CMS's list of PREV services be segregated into logical and insightful categories?  EG GLAUCOMA and BMM are really "management of disease".  GLAUCOMA is left out of UPSTF, and USPSTF handles BMM very differently.

Inbtriguing phrase "screening, and other preventive services"  (E.g. OCP's are not screening, baby aspirin is not screening)

Wich are TESTS and which are nOT

ssa 1861

(ww)(1) The term “initial preventive physical examination” means physicians’services consisting of a physical examination (including measurement of height, weight, body mass index, and blood pressure) with the goal of health promotion and disease detection and includes education, counseling, and referral with respect to screening and other preventive services described in paragraph (2), end-of-life planning (as defined in paragraph (3)) upon the agreement with the individual, and the furnishing of a review of any current opioid prescriptions (as defined in paragraph (4)), but does not include clinical laboratory tests.[533]

(2) The screening and other preventive services described in this paragraph include the following:

(A) Pneumococcal, influenza, and hepatitis B vaccine and administration under subsection (s)(10).

(B) Screening mammography as defined in subsection (jj).

(C) Screening pap smear and screening pelvic exam as defined in subsection (nn).

(D) Prostate cancer screening tests as defined in subsection (oo).

(E) Colorectal cancer screening tests as defined in subsection (pp).

(F) Diabetes outpatient self-management training services as defined in subsection (qq)(1).

(G) Bone mass measurement as defined in subsection (rr).

(H) Screening for glaucoma as defined in subsection (uu).

(I) Medical nutrition therapy services as defined in subsection (vv).

(J) Cardiovascular screening blood tests as defined in subsection (xx)(1).

(K) Diabetes screening tests as defined in subsection (yy).

(L) Ultrasound screening for abdominal aortic aneurysm as defined in section 1861(bbb).

(M) An electrocardiogram.

(N) Screening for potential substance use disorders.[534]

(O) Additional preventive services (as defined in subsection (ddd)(1)).

CONTINUE AS DDD BUT LIST NCDS FOR PREVENTIVE SINCE 2008