Sunday, November 12, 2023

Podcast Watch: History and Issues for Genomics Coding (Jim Almas, Perry Dimas, "Promise of Personalized Medicine"

In the podcast realm, one new episode of particular interest is, "Deciphering the Code: The Complex World of Genetic Test Coding."  This is an October 17 interview with Jim Almas MD, who's worked with hospitals, CMS, MolDx, and most recently LabCorp.  At LabCorp, he has the intriguing title, "National Medical Director ofr Clinical Effectiveness," with a role in evaluating new products and services. Dr Almas is also experienced with the complex worlds of AMA CPT committees and working groups.

Find it on the series, "The Promise of Personalized Medicine," with host Perry Dimas.   On multiple podcast servers, and on the web at:

History of Z Codes

The episode recounts the history of Z codes at MolDx, and recalls early protests that they weren't concordant with HIPAA.  An early comment letter from ACLA, with elaborate HIPAA argumentation, is still online here.  That's December 2011.

An even older document, a white paper I wrote on coding with a small commission from Greg Downing at HHS, is still online; 2008; here.   That summer I had the chance to discuss the findings in DC at HHS with Ben Sasse, then an assistant secretary at HHS and later a senator.


AI Corner / Auto Summary

You'll want to hear the whole podcast, but here's an instantaneous AI summary (GPT4):

The podcast titled "The Promise of Personalized Medicine" features Perry Dimas as the host and Dr. Jim Almas as the expert on laboratory medicine. They discuss the advancements and challenges in genomics laboratories, focusing on issues such as coding and insurance coverage for genomic tests.

Dr. Almas emphasizes the relatively recent focus on personalized medicine, noting significant discussions started around 2015 when governmental agencies like CMS, NIH, and FDA began to collaborate to further the updtake of genomics. He highlights his work with the AMA on coding systems for genomic tests and mentions the importance of showing clinical utility to secure insurance coverage. He also talks about the financial considerations that health plans have when deciding whether to cover new tests.

The conversation reveals the complexity of coding systems like AMA's CPT codes, MolDx's Z codes, and Concert Genetics' approach. The speakers agree that no single solution is perfect for coding genomic tests. Dr. Almas suggests that a hybrid system might be more effective, but political and financial issues must be balanced.

Coverage of tests by payors is a significant topic. Dr. Almas points out the commercial health plans' practical approach to coverage decisions and stresses the importance of demonstrating that a test will lead to better patient outcomes or cost savings.

Furthermore, Dr. Almas has comments on the current coding system, which may fall short, and calls for a more precise identification of tests. He describes a recent incident where lax controls allowed for significant abuse in claims for genetic testing, arguing for tighter regulations. [2023 OIG report here.]

In the end, Dr. Almas advises diagnostic companies to define their tests' intended use clearly, engage in multiple studies, partner with academic centers, and not fear the feedback but use them to refine their assays.

Overall, the podcast sheds light on the current state of personalized medicine in the laboratory setting, the challenges of coding and coverage, and the potential paths forward for improving the system.


Humor Corner

We show whether AI can make a comic version of a coding interview, here.