Tuesday, December 7, 2021

AMA CPT Update: Clinical Pathology Consultation - Complexified !

For years, we've had two approaches to pathologist consultations.   Codes 80500 and 80502 were clinical pathology consultations, valued at $22 with 22,000 uses and $73 with 13,000 uses.

Turning to anatomic pathology, for review of outside slides, or if needed making new slides, we had codes 88321, 88323, 88325 ($99, $115, $167, with utilization 182,000, 35,000, 11,000).


Now for 2022 we have several new codes for pathology clinical consultation.  Although they seem geared to clinical pathology (and one might think especially genomics), each includes a valuation for microscope use as a practice expense for the whole service (at 15, 30, or 54 minutes).  Note that AP slide review codes 88321 etc. continue unchanged in 2022.

More notably, the instructions for 80503-80506, replacing 80500,80502, are vastly more complex.  Instead of a sentence or two, the instructions now run several pages.  I've clipped screen shots below although they are not legible, to avoid interfering with AMA copyright.

80503 accounts for 5-20 minutes of total time, 80504 for 21-40 minutes, and 80505 for 41-60 minutes.  Additional half-hours bill as 80506.  Billing can be for time alone, or, for complexity levels elaborately defined (rather like E/M visits have elaborate decision levels).  The CMS RVU valuation, published 11/2021, is here.  86 FR 56101-2.

The total non facility RVUs, per the November 18 final rule, are below.  I've used a simple placeholder conversion factor of $36.  Recall the old code pair was $22 simple and $73 complex.

80503  .77 or $28

80504  1.54  or $55

80505  2.79   or $100

80506  1.25  or $45