Managing any large pathology practice to provide clinical services efficiently is a complex task. In academic practices, clinical, teaching, and research responsibilities must also be balanced. Changing health care financing and increasing stringency of health care regulation complicate this task. This course presents practical current information and organizational models for large and academic pathology practices seeking to operate effectively within these constraints. Specific topics are: 1) models for the equitable allocation of subspecialty staffing in large pathology practices; 2) coding for pathology services, including complex coding decisions in referral practices; 3) the regulatory basis and general structure of compliance programs for pathology practices, including consultation and teaching services.

Decreasing unit reimbursements make efficiency in the practice of surgical pathology and cytopathology increasingly important. Unlike the semi-industrial, high fixed/low variable cost model for clinical laboratories, anatomic pathology offers relatively little volume efficiency, but appropriate subspecialization can increase productivity by decreasing variability. In the context of an academic practice, this is additionally beneficial in aligning each pathologist’s clinical work and academic area. Models for the equitable allocation of staffing among a mix of subspecialized services will be presented and discussed.

Correct coding in each of two systems (CPT and ICD) is a major factor in compliance, as well as a key determinant of reimbursement. Though CPT terminology in pathology is for the most part clear, National Correct Coding Initiative edits’ effect on large specialized or academic practices is less well appreciated. This will be reviewed, with citation and discussion of authoritative coding information. In particular, the conditions and requirements of providing, coding, and billing for consultative services will be addressed, with consideration of the perspectives of the consulting and the referring communities of pathologists. Finally, application of the ICD coding system to pathology specimens presents some practical difficulties, and appropriate coding guidelines will be presented and discussed.

An effective compliance program needs to address seven issues. These will be presented in context of the legal rationale and practical implementation of such a program. Participant interaction will be encouraged to address issues and concerns specific to individual practice settings.

No materials will be mailed in advance, but a comprehensive syllabus will be distributed at the time of the course.

(Last scheduled presentation)