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POL Symposium helps physicians become CLIA-certified lab directors. (POL Adviser).

The 17th annual Physician's Office Laboratory (POL) Symposium, jointly sponsored by the University of Maryland School of Medicine and COLA, a national laboratory accreditation organization, was held Oct. 31 through Nov. 3 in Baltimore.

Since 1990, Nancy Dennis, program director of the POL Symposium, has been perfecting her meeting to help physicians understand good laboratory practices. Once CLIA '88 (Clinical Laboratory Improvement Amendments of 1988) became effective in September 1992, she upgraded the programs content to include 20 continuing medical education (CME) credits of CLIA '88 compliance education. The 20 CME credits enable physicians to meet the qualification requirement for directors of a CLIA moderate-complexity laboratory. This is currently the only meeting in the country that offers the necessary credit hours for physicians to meet these requirements.

This year's program started on Halloween night-coincidently, the same date CLIA '88 was signed into law by President Reagan. In addition to CLIA education, attendees could choose to receive updates on regulatory and management issues associated with operating a physician office laboratory.

This year's attendees of the intensive two-and-a-half-day meeting had the opportunity to obtain their CME credits in 19 general session presentations, four of the 17 two-hour workshops, and two working lunches. The following highlights several points made at the meeting.

Advanced Beneficiary Notices

On Oct. 1, the industry was required to initiate use of a new Advanced Beneficiary Notice (ABN) issued by the Centers for Medicare and Medicaid Services (CMS). Like the old ABN, the new form is to be given to a Medicare beneficiary when there is a likelihood that he or she will need to be financially responsible for the provided laboratory service if the Medicare program does not pay. An ABN empowers a beneficiary in the decision of whether or not a laboratory service should be rendered when the beneficiary is going to be responsible for payment. One difference with, the new ABN is the option to provide the beneficiary with information about the cost of the service. Although providing cost information is not a CMS requirement, if it is provided, it is important that it accurately reflect the beneficiary's financial liability. If the cost estimate is high, there is fear this may influence a beneficiary to choose not to order the service because of worries about the expense. On the other hand, an underestimate may cause a beneficiary to opt for the service, which then may lead to a financial hardship when the higher bill arrives. The latter situation is almost certain to reflect poorly on the entity that issued the ABN.

National coverage decisions

Effective Nov.25, the laboratory industry must adhere to National Coverage Decisions (NCDs) for 23 tests that encompass 63 Current Procedural Terminology (CPT) codes. The NCDs will replace Local Medical Review Policies (LMRPs) where duplication exists. The NCDs cover 43 percent of all Medicare carrier (payers) laboratory services and 51 percent of carrier payments for laboratory services. An NCD is a Medicare coverage policy that defines medical necessity for certain Medicare services. Physicians use these policies to determine when it is appropriate to provide an ABN to a beneficiary. These polices will be provided to physicians via their Medicare carrier's notices. The policies can be downloaded via the Internet: http://cms.hhs.gov/manuals/pm_trans/ABO2110.pdf.

Final CLIA regulations

It's only been 10 years since the effective date of CLIA '88, and the final regulations are due out by the year's end. The purpose of the final CLIA is to address all the comments (60,000 of them) that were generated by the rule published in 1992, update and finalize the quality control regulations, finalize the high-complexity director requirements, and consolidate and refocus the current requirements to read like a specimen going through a laboratory. The rearrangement of the requirements will remove redundancy and simplify understanding them. The current subparts--J: Quality Control, K: Patient Test Management, and Q: Quality Assurance--will be combined into two parts: Facility Administration and Quality Systems.

New CPT codes

The issuance of the 2003 CPT code book marks another year where significant changes have been made to the laboratory codes. The majority of changes are in the hematology codes. The table at right describes the 2003 laboratory CPT code changes.

RELATED ARTICLE: 2003 laboratory CPT code changes

Additions: 12; Deletions: 14; Description changes: 18; Missed changes: 2; Previous deletion verbiage changes: 3; Total: 49

Organ or disease oriented panels

Changes to panel descriptors should read (not in new 2003 book)

80050: General health panel includes: new hematology code 85025/85027 plus 85004/85007

80055: Obstetric panel includes: new hematology code 85025/85027 plus 85004/85007

Deletion

80090: TORCH antibody panel: 86644, 86694, 86762, 86777. (To report, see codes for specific tests)

Chemistry

Additions

83880: Natriuretic peptide

84302: Sodium; other source

Verbiage changes to previous deletions

82620 has been deleted. (For cystine and homocystine, quantitative, see 82131, 82136, 82139)

Hematology

Additions

85004: Blood count; automated differential WBC count

85032: Blood count; manual cell count (erythrocyte, leukocyte, or platelet) each

85049: Blood count; platelet, automated

85380: Fribrin degradation products; ultrasensitive (e.g., For evalutation for venous thromboembolism), qualitative or semiquantitative

Changes to descriptors

85007: Blood count; blood smear, microscopic examination with manual differential WBC count

85008: Blood count; blood smear, microscopic examination without manual differential WBC count

85009: Blood count; manual differential WBC count, buffy coat

85014: Blood count; hematocrit (Hct)

85018: Blood count; hemoglobin (Hgb)

85025: Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC, and platelet count) and automated differential WBC count

85027: Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC, and platelet count)

85041: Blood count; red blood cell (RBC), automated

85044: Blood count; reticulocyte, manual

85045: Blood count; reticulocyte, automated

85048: Blood count; leukocyte (WBC), automated

85378: Fibrin degradation products, D-dimer; qualitative or semiquantitative

Deletions

85021: Blood count; hemogram, automated (RBC, WBC, Hgb, Hct and indices only)

85022: Blood count; hemogram, automated and manual differential WBC count (CBC)

85023: Blood count; hemogram and platelet count, automated, and manual differential WBC count (CBC). (To report, use 85007 and 85027)

85024: Blood count; hemogram and platelet count, automated, and automated partial differential WBC count (CBC). (To report, use 85025)

85031: Blood count; hemogram, manual, complete CBC (RBC, WBC, Hgb, Hct, differential and indices). (To report, use 85014, 85018 and 85032)

85585: Platelet; estimation on smear, only. (To report, use 85008)

85590: Platelet; manual count. (To report, use 85032)

85595: Platelet; automated count. (To report, use 85049)

Transfusion medicine

Changes to descriptors

86930: Frozen blood, each unit; freezing (includes preparation)

86931: Frozen blood, each unit; thawing

86932: Frozen blood, each unit; freezing (includes preparation) and thawing

Deletion

86915: Bone marrow or peripheral stem cell harvest, modification or treatment to eliminate cell type(s) (e.g., T-cells, metastatic carcinoma)

Microbiology

Additions

87255: Virus isolation; including identification by non-immunologic method, other than by cytopathic effect (e.g., virus specific enzymatic activity)

87267: Infectious agent antigen detection by immunofluorescent technique; enterovirus, direct fluorescent antibody (DFA)

87271: Infectious agent antigen detection by immunofluorescent technique; cytomegalovirus, direct fluorescent antibody (DFA)

Changes to descriptors

87207: Smear, primary source with interpretation; special stain for inclusion bodies or parasites (e.g., malaria, coccidia, microsporidia, trypanosomes, herpes viruses)

87254: Virus isolation; centrifuge enhanced (shell vial) technique, includes identification with immunofluorescence stain, each virus

Deletions

87198: Cytomegalovirus, direct fluorescent antibody (DFA). (To report, use 87271)

87199: Enterovirus, direct fluorescent antibody (DFA). (To report, use 87267)

Cytopathology

Additions

88174: Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin-layer preparation; screening by automated system, under physician supervision

88175: Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin-layer preparation; with screening by automated system and manual rescreening, under physician supervision

Deletions

88144: Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin-layer preparation; with manual screening and computer-assisted rescreening under physician supervision

88145: Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin-layer preparation; with manual screening and computer-assisted rescreening using cell selection and review under physician supervision

Verbiage changes to previous deletions

88170 has been deleted. (To report, see 10021, 10022)

88171 has been deleted. (To report, see 10021, 10022)

Other procedures

Additions

89055: Leukocyte count, fecal

Changes to descriptors

89310: Semen analysis; motility and count (not including Huhner test)
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Article Details
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Title Annotation:Physician's Office Laboratory Symposium
Author:Pontius, C. Anne
Publication:Medical Laboratory Observer
Geographic Code:1USA
Date:Dec 1, 2002
Words:1376
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