McKesson and the American Medical Association (AMA) have entered into a pact intended to provide greater coding clarity to the thousands of molecular assays available to the health care profession.
Under the licensing agreement announced late last month, McKesson’s Z-Code identifiers will be grouped and indexed to AMA’s corresponding Current Procedural Terminology (CPT) code set.
Both McKesson and the AMA say the licensing agreement is intended to clear some of the confusion on how to classify the crush of molecular tests. More than 3,000 currently exist, and their popularity is rapidly growing. The parties had been in negotiations for a licensing pact for a year prior to its announcement.
“Greater clarity will bring health care stakeholders one step closer to the collaboration needed to assess these tests and make the most informed test selection, coverage, and payment decisions, resulting in better business for providers and payers and better care for patients,” said McKesson Health Solutions President Emad Rizk, M.D.
In a 2011 white paper, McKesson advocated for greater clarity in classifying genetic tests, noting for example that patients who take drugs on a long-term basis might benefit from specific molecular procedures to determine if they are properly metabolizing them.
The pact with the AMA is expected to provide much greater visibility and viability to the McKesson Diagnostics Exchange, which the Newtown, Mass.-based company launched in 2011 for molecular laboratories to submit information about their specific tests for cataloging.
“The added capabilities will complement the AMA’s ongoing development and maintenance of a CPT code set for molecular diagnostic services and provide a valuable tool for physicians, hospitals, payers, and the diagnostics industry that will help organize vital information about [molecular diagnostic] tests,” said James L. Madara, M.D., the AMA’s chief executive officer.
There are currently 114 molecular CPT codes. McKesson spokesperson Sandra Cummings said that the joint effort is expected to cause that number to grow significantly.
“The AMA will be actively recruiting laboratories and other important stakeholders to participate in the mapping process,” Cummings said.
Imperfect Art
However, assigning CPT codes to the Z-Codes is expected to be an imperfect art at best. In a joint statement, the parties noted that “not all Z-Code Identifiers will immediately map to a CPT code, and, in many cases, multiple Z-Code identifiers will map to a single CPT code.” Cummings ruled out any chance that this might create a new form of molecular code stacking. The Centers for Medicare and Medicaid Services late last year eliminated that practice for Medicare billing using the existing molecular codes.
Cummings declined to disclose any terms of the deal, but trade associations such as the AMA typically charge outside parties to partake of services they provide.
The Chicago-based AMA said it would offer the mapping service to its membership and other parties in early 2014 and that it will be licensed like its other CPT-related products.
Cummings also said McKesson did not plan to commercialize any of the information it is gathering from laboratories on its molecular tests.
“McKesson supports the collection of the data within the diagnostics exchange but it does not assert any ownership or control over the data,” she said, adding that no proprietary data gathered from labs would be used in any way without their consent.
