In the era of precision medicine, where genetic insights drive patient care, genomic laboratories and screening centers are increasingly relying on specialized genomic lab coding companies who can deliver accurate genomic lab coding services at scale.
For over a decade, our tailored solutions have enhanced precision in coding for labs and screening centers across the US.
Challenges Faced by Genomic Labs
A recent survey among Genomic and Molecular labs highlighted the magnitude of these challenges:
- 82% faced accuracy issues in coding
- 78% struggled with evolving coding requirements
- 65% expressed concerns about the lack of standardization in coding practices
HFMA data indicates that a 120-day reimbursement delay for genomic testing is affecting the financial health of Genomic Labs.
The reasons behind these alarming figures are:
1. Complexity of Genomic Data:
Navigating the intricate landscape of genetic variants, associated diseases, and medical guidelines demands specialized expertise.
We address this challenge by investing in specialized training for our coders. This includes in-depth knowledge of genomic terminology, genetic variants, and relevant medical guidelines.
2. Rapidly Evolving Genomic Landscape:
Staying abreast of ever-changing coding requirements poses a continual challenge.
To stay ahead, we always update our coding practices to match the changing genomic landscape. This ensures our coders are well-versed in the latest coding requirements.
3. Inconsistent Reimbursement Policies:
Varying policies among insurance payers create uncertainties for labs and patients alike.
We tackle this issue by developing and adhering to consistent coding practices tailored specifically for genomic testing. This ensures accuracy and transparency, reducing uncertainties related to reimbursement.
4. Lack of Standardization:
Inconsistent coding practices across labs hinder accurate reimbursement and data analyzing.
Our approach involves standardizing coding practices to ensure uniformity across all processes. This not only facilitates accurate reimbursement but also enhances the ability to analyze data.
5. Limited Coding Resources:
Companies without adequate specialized coders struggle to accurately code complex genomic tests.
Our vast pool of trained resources offers unmatched flexibility and cost-savings, augmenting enterprises with limited in-house resources.
Genomic Lab Coding Services for Diagnostic Genomics
Understanding the coding landscape is crucial for Genomic labs. Our experts have extensive knowledge of CPT coding, historical molecular stacking codes, and the development of new CPT codes.
A foundational understanding of the coding framework that drives precision medicine is key to accurate and comprehensive coding.
Historical Molecular Stacking Codes:
Before 2013, genetic and molecular pathology tests were grouped as stacking codes for reimbursement.
The AMA later revamped this system by introducing tiered codes:
- Tier 1 codes for analyte-specific codes
- Tier 2 codes
- Multianalyte Assays with Algorithmic Analyses (MAAs).
Reasons for New CPT Codes:
The shift aimed at addressing payer demands for transparency and granular understanding of reimbursements. A response to the need for a comprehensive coding system reflecting the diversity of molecular tests performed.
Analyzing Test Distribution:
In-depth analysis of assays nationwide pinpointed about 100 tests, encompassing a substantial portion of all performed tests. Tier 1 codes were implemented for the top 100 gene- and analyte-specific tests, amplifying specificity in coding.
Tier 1 Code Format:
Tier 1 descriptors are structured with HUGO-approved gene symbols, long gene names, illustrative disease/condition examples, and gene analysis types. While disease/condition examples are not exhaustive, they offer context within this structured format.
Tier 2 Codes:
Approximately 600 tier 2 codes for lower-volume assays were issued and categorized into nine complexity levels. Complexity levels range from basic variant testing to intricate sequencing involving greater than 50 exons.
Coding Change Proposals:
Laboratories can propose transitioning a code from tier 2 to tier 1 through a formal coding change proposal. Submission requirements comprise a clinical vignette, a thorough service description, and evidence supporting clinical validity.
Examples of CPT and HCPCS Codes in Diagnostic Genomics:
To illustrate the depth of genomic coding, here are some examples of CPT and HCPCS codes:
- 81442: Molecular pathology procedure, Level 6.
- 81479: Unlisted molecular pathology procedure.
- 81292: Molecular pathology procedure, Level 2.
- S3870: CGH test developmental delay.
- J9022: Injection, atezolizumab, 10 mg.
- G0452: Molecular pathology interpret.
The codes above only hint at the wide spectrum of genomic procedures, reflecting the diversity and complexity of genomic testing. It is quite apparent that coding services for Genomic Lab practices requires a high degree of specialized knowledge and acumen.
In the context of Genomic Lab coding services, we navigate the evolving landscape of NGS panels, pan-tumor biomarkers, and emerging immunotherapies. Decode the complexities of solid organ neoplasm analyzing, from NSCLC to mCRC, ensuring compliance with CMS guidelines. Trust us to accurately code for genetic variants, TMB, and MSI.
Reasons to Outsource Coding Services for Genomic Labs
Recognizing the magnitude of these challenges, labs have increasingly begun to outsource genomic lab coding to reliable genomic lab coding support. Relying on providers who have deep experience has emerged as a strategic and pragmatic solution. The benefits are compelling:
Reduced Costs: Augment or reduce in-house hiring and training and significantly bring down costs.
Improved Efficiency: Benefit from our established workflows which are optimized for efficiency.
Enhanced Accuracy: Access our pool of experienced coders with deep expertise in genomic coding.
Specialized Expertise: Tap into specialized knowledge that takes care of all regulatory and compliance issues.
Reduced Administrative Burden: We handle all coding-related paperwork and communication with insurance payers, reducing the administrative load on your staff.
Complete Coding Support for Genomic Lab Practices
Your search for dependable and accurate Genomic Lab coding services ends at Sunknowledge. Our coding proficiency, seamless workflow and complete dedication towards client satisfaction have enabled us to provide exceptional genomic lab coding support to our partners. By consistently delivering the highest quality billing & coding support to specialized healthcare practices, we have emerged as the preferred destination to outsource coding services for Genomic Labs.
Learn more about our processes and how they optimize revenue cycles by scheduling a no-strings-attached, free consultation with our experts. Book your slot today.