PAMA and the various combinations of 8 BRCA-related codes makes it even weirder than it used to be.
I've assembled the BRCA services and coding options in the picture below, along with PAMA data for utilization and newly released PAMA median prices. (Note, I've doubled the PAMA utilization to extrapolate from the sixth-month survey to a 12-month year.) Click to enlarge, review, then continue.
|click to enlarge|
But wait, there's a whole 'nother level of weirdness, as the pricing for single-gene BRCA1 sequencing plummets to $75 and single-gene BRCA2 sequencing plummets to $185. (Note that these codes got only a couple dozen uses in the PAMA year, whereas BRCA1-2 sequencing was about 200,000 uses.)
This means there are several ways to build up coding for exactly the same major BRCA services: "Full sequencing of BRCA1 and BRCA2 and analysis of both common and uncommon deletions."
The most code-efficient way (which seems like correct coding to my eye) is 81162, paying $1615. However, look harder and you'll find the highest sum comes from billing as BRCA 1-2 sequencing (81211, $2395) and uncommon deletion analysis (81213, +$553), totaling an impressive $2948, almost double the value we get for using the parent code 81162.
But look closely and there's a third option, to order BRCA1 sequencing alone, with its common dup-del analysis, 81214, a frugal $75, and then order BRCA2 sequencing, 81216, for a still budget-friendly $185. You're almost done: just order 81213 to wrap up those uncommon DupDels ($553). Your shopping cart gives you all those BRCA services, soup to nuts, and costs you only $813, half the price of 81162, and only about a quarter of the most costly coding option for the same sequencing reports. It's like those sales that get you one-way to Europe for $250.
To my eye, the simple coding is 81162. I've said that. But if you're going to break up 81162 into 81211+81213 (if you're gonna say that is kosher coding), why not do it again, and break up the 81211 into its component codes of 81214+81216?