Laboratory Question for the Week of January 29, 2018

Question:

As I understand the Medicare rules, physician interpretation of a molecular pathology procedure (e.g., CPT^® codes 81161–81408) may be reported with HCPCS code G0452 (molecular pathology procedure; physician interpretation and report) as long as certain criteria are met. What are those criteria?

Answer:

According to the Centers for Medicare & Medicaid Services (CMS) in section L of chapter 10 of the 2018 National Correct Coding Initiative Manual for Medicare Services, G0452 may be reported if the following circumstances exist.

• The attending physician requests the interpretation.
• The interpretation results in a written narrative report.
• The interpretation requires the exercise of medical judgment (i.e., a nonphysician laboratory specialist did not provide the information).

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