President's Message

By Susie Adams

I find the Holiday Season is a time to reflect on the past year and make plans for year to come. It seems appropriate for me to share with you the privilege I have had this past year to work with the professional Board Members of CLMA. I serve on many boards and this board is very different. Each member is actively involved and takes responsibility. It is a pleasure to serve with them and I want to thank each and every one for their time energy, and expertise. The first of next year we will complete the process of applying for chapter of the year. This has and will require many dedicated hours volunteers are welcome. I invite all members to consider running for the board or a committee and encourage their associates to do the same. We meet monthly but try to reduce time by using e-mail, conference calls, and fax.

On that order, one of our objectives this year is to improve communication. It has been slower that we had hoped. However, we now have the beginning of a Web Site and are attempting to communicate through e-mail. Pat Martin sent a survey to all members via e-mail. It appears he has not been able to access some of the responses. To date we have only received five responses (we know more have been sent). Please indulge us and fill out the survey (again) in this letter and fax it to Pat. The purpose is to evaluate the effectiveness of the educational programs, look for new ideas (we can only serve your needs if we know what they are), and identify members interested in serving CLMA.

We have a busy Schedule.

January 13th

Rand Kerr, Assistant Administrator at St. Mark's Hospital will be our speaker for the Power Breakfast. "Healthcare Revisited" is a continuation from a program two years ago. Each major hospital system in the area shares their unique perspective on the market, their position, and their vision for the future.

January 23rd & 24th

The CLMA Leadership Week, Council of Chapter President's (CCP) meeting is in Orlando, Florida. This is open to any member and has no registration fee. If you want more information call either Dave Young or myself. Congratulations to Dave for being named to the CCP Board!

March 8th & 9th

Mark your calendar for the Spring Conference in Ogden. Let's all show our support for the joint USCLS/CLMA meeting.

I wish you all the warmest thoughts and Best Wishes for a wonderful Holiday Season and a Very Happy New Year.

STRESSED? TRY CLMA

By Ann Merkley, CLMA Board

Stressed out with the holidays? Or just with life in general? Me too! In fact, its been one of those years where I could
check about 100 points on one of those "How Much Stress is There in Your Life" articles in a magazine-new job, loss
of a parent, caring for my elderly father and young children at home (the sandwich years, so aptly named!), older
children graduating from high school, sending these same young adults away to college and far away on missions,
major surgery on spouse (I didn't perform it but it stressed me out!), and now the holidays with the many "to do" lists
that come with it-Its enough to drive me bonkers! Can you relate?

So as I reviewed my life recently, I thought I ought to cut out a few things and reduce the stress-what could go? My
children (sometimes tempting, but not an option), my job (no, I'm too old to quit and too young to retire), caring for my
father (no-- after all, he cared for me for many years). So what could I cut? The thought came to me that maybe I ought
to drop CLMA. Well, that thought stayed only a few seconds. You see, I have found CLMA and the friends and
associations I have made here to be strengthening and food for my soul in a stressful, busy world. I don't want to give
up the Power Breakfasts where I see friends and associates from many years ago and friends and associates I've met
recently through CLMA. And not go to Spring Seminar or the CLMA mid-year meeting? Both of those meetings are
wonderful opportunities to learn and grow. (My husband is still talking about the Zions meeting in 1997!) And you
know what else-we're all in stressful, busy careers and it helps to be able to talk it over with colleagues who know
exactly what you mean!

So I urge all of you to participate in CLMA activities. Utilize the networking opportunities. We all need the
comradeship this organization provides. It also provides excellent information that is extremely helpful in our jobs.
And find a friend who could benefit from joining CLMA! An application is included in this newsletter edition for just
that purpose. You won't be sorry and your friend won't be sorry!

The Other Side of Utah History

Spring Seminar 1999

By Michael A. Beard

Hey! Did you know there is another more wild side of Utah history? Check out Ogden by coming to the Spring Seminar
this coming March 8 and 9. This year the continuing education meeting will be held in historic Ogden City at the
beautiful, unique, and newly renovated Egyptian Center.

Stay at the historic renovated Radisson Suites Hotel, (phone 627-1900). You'll get a suite and full breakfast for a
price less than other nice single rooms, (about $65 for two), tell them you're with the USCLS/CLMA convention. Bring
the family. Participate in the historic walking tour led by Ogden historian Dr. Richard Roberts. See the area that
shattered the Mormon's dream of an isolated empire when the Transcontinental Railroad was completed in 1869. The
influx of Chinese, Irish, Italians, Jews, Japanese, and others opened up Ogden as the melting pot of Utah. Of course
this brought with it some of the wild history of the opium dens (hop houses), gambling parlors, and houses of
prostitution. Anyway the colorful history of Ogden will come to life with the help of Dr. Roberts.

This tour is sponsored by USCLS and CLMA for all participants, exhibitors and their guests. The tour will begin at
the Radisson, go down the wild and wooly twenty fifth street to the old Union Station that houses the Browning
Firearms Museum, the Kimball Car Collection, the Railroad Museum, the Gem & Mineral Society exhibits, and other fun
stuff. Take the family to the Eccles Dinosaur Park, the Hill Aerospace Museum, and the Golden Spike National Historic
Site. These places will be available at no cost or reduced cost for participants, exhibitors and guests.

This may be the opportunity to get that tax deductible romantic getaway you've been looking for. Even if you do
bring the kids, they may find they like some of the fun at the Tree House in Ogden Mail right adjacent to the Radisson.

Mark your calendars set up the date with your significant other and I'll see you there.

Health Care Policy

By Paul Keoppel

Carrier Advisory Committee

All Medicare carriers are required by law to have an advisory committee. The charge of this committee is to review any policies before the local carrier publishes them as notices. The Balanced Budget Act requires that at least one member of this committee be from the laboratory. We are pleased to announce that Dr. Ron Weiss from ARUP is serving on the Utah Medicare Carrier Advisory Committee (CAC). He will be a great resource for us in the laboratory community. He will supply us with information that the committee is discussing and bring feedback after committee meetings. If you have any questions that you would like posed to Medicare provide them to the health care committee and we will forward them to Dr. Weiss.

Negotiated Rulemaking

The Negotiated Rulemaking Act sets out a process in which a proposed rule is developed by a committee of
representatives of interests which may be significantly affected by the rule. The Balanced Budget Act requires HCFA to use negotiated rulemaking to develop national coverage and administration policies for clinical laboratory tests. There are about 7 issues being negotiated. The meetings started in July of this year and have a deadline of January 1, 1999 for a product.The panel of negotiators, of which CLMA is one, originally identified over 100 tests that could be candidates for national policies. Participants in the rulemaking have conceded that this was overly ambitious, given the time allowed. The current, semi-final list contains 23 tests or closely related groups of tests as policies. The original list contained tests that never had a local policy and no reason could be substantiated for having a national limited coverage policy where no state had a local policy. The policies, including the acceptable ICD9 codes can be reviewed at www.hcfa.gov/quality/qlty-8a.htm. We understand that the proposed rule will be published in May for comments and the final rule printed in September of 1999, so will are probably a year away from implementation. The tests are:

blood glucose

Collagen cross-links

Glycated hemoglobin/protein

Thyroid testing

Digoxin TDM

lipids

blood counts (CBC)

PTT

protime

Iron studies

AFP

CEA

Flow cytometry

Free PSA

PSA

HCG

Tumor antigen by immunoassay

culture, bacterial, urine

HIV

fecal occult blood

gamma glutamyl transferase (GGT)

hepatitis panel

Of note to labs in Utah, the platelet CPT code has not been split off of the CBC as it is now.

UTAH CLMA WEB Page

The Web page for the Utah Chapter is finally coming to fruition. The board has had a desire for a long time of having a place for members to locate information about the Utah Chapter. The site is being programed one page at a time. Rather than wait until everything is polished and complete we decided to publish as we construct (design build??). Keep checking back often for the latest. The site, when complete, will have pages for:

Leadership- This will list the board members and their e-mail addresses. Board meeting minutes will also be
posted here.

Education

Membership- This page lists the membership committee and has a link to the CLMA national membership web
page.

Newsletters- Current and past issues of the Utah Chapter newsletter.

Strategic Plan

Collaboration- this page consists of Internet links that you may find useful.

Health Care Policy

Job Marketplace

Upcoming events- A place to spotlight the next upcoming meeting

Bylaws

Feedback- A place to send us your e-mail comments, suggestions or questions.

The web page is located at http://users.sisna.com/paulk

Type in the address once and save as a bookmark (Netscape Navigator) or favorite place(Internet Explorer).

Compliance Update

By Paul Keoppel

1999 CPT Codes

The 1999 CPT codes have been published by the AMA. There are several revisions, additions and deletions. Here are some of the changes.

Revised 80054 Compressive metabolic panel- add carbon dioxide(82374); substitute bilirubin, total(82247) for bilirubin, total or direct (82250) 80058 Hepatic function panel- delete bilirubin, total and direct (82251) and add bilirubin, total(82247) and bilirubin, direct(82248) 84153 Prostate antigen (PSA), total; is for total only, separate CPT for free PSA

Several changes were made for cytology codes. If your lab performs cytology, refer to the 1999 CPT book for the
revisions.

Additions

82247 Bilirubin, total

82248 Bilirubin, direct

84154 Prostate specific antigen (PSA), free

85046 Blood count; reticulocytes, hemoglobin concentration

Several new cytology codes have been added to provide for automated screening and review

Deletions

82250 Bilirubin, total or direct (use 82247 or 82248)

85029 Additional automated hemogram indices-no one should have been using this code anyway, because the
calculated indices is part of the hemogram 85030 Four or more indices- likewise

Summary

The long hoped for separation of the total and direct bilirubin codes finally happened. Labs have had problems billing a direct bilirubin in conjunction with a comprehensive metabolic panel because the carrier could not tell for sure if the bilirubin charge was duplicate or not.The biggest surprise here was the unforseen addition of the Co2 to the compressive metabolic panel. The 1999 Medicare Clinical Diagnostic Fee Schedule is out (go to the national CLMA web site to get a link to it). The reimbursement for the 80054 comprehensive CPT code has went from $12.48 in 1998 to $14.61 for 1999, with the addition of the Co2, assuming that medical necessity criteria are met. That creates a problem.  In most cases ambulatory patients, unlike hospital inpatients, seldom have the kinds of conditions that would justify performing this test. Another problem for some labs is that they are not set up to perform Co2 as part of the panel because the specimen requires special handling to avoid an invalid result. If your lab cannot perform the Co2 test, you cannot bill the 80054 procedure code. How fast can you say "Medicare Limited Coverage Test" for this code if the Co2

says in the panel?