1. Tamara Toney
   Posted 7 months ago #
   

   Recently Medicare denied payment on a case we received at our facility. We believe Medicare denied payment because of the # of Level 5 biopsies charged.

   They might be questioning specimens “D” through “F” as specimens being evaluated for margins.

   Please take a look at all the parts, the charges we submitted and give us your recommendations for the correct CPT Codes.

   SPECIMEN CPT CODES USED
   A. Sentinel Node #1 (frozen)
   88307 – prof
   88307 – tech
   88331 – froz prof
   88331 – froz tech
   B. Sentinel Node #2 (frozen) 88307 – prof
   88307 – tech
   88331 – froz prof
   88331 – froz tech
   C. Right breast lumpectomy (specimen 6 margins inked)
   88307 – prof
   88307 – tech
   D. Right breast inferior margin (3.0 x 2.5 x 2.0 cm inked red)
   88307 – prof
   88307 – tech
   E. Right breast superior margin (3.2 x 1.0 x 1.0 cm inked yellow)
   88307 – prof
   88307 – tech
   F. Right breast medial margin (3.1 x 2.2 1.8 cm inked orange)
   88307 – prof
   88307 – tech
   G. Right breast lateral margin (3.5 x 3.0 x 2.0 inked green)
   88307 – prof
   88307 – tech
   H. Right breast deep margin (2.0 x 2.0 x 0.5 inked black)
   88307 – prof
   88307 – tech

2. SuperCoder
   Posted 7 months ago #
   

   You can't bill for the margins separately. Breast excision of lesion requiring microscopic evaluation of surgical margins can be coded as 88307. We can't code 88307 for excision of breast lesion and breast margin separately for each.
   So, codes for 6 margins [as indicated in 'C' for lumpectomy], from "D" to "F" here are included in "C". So, medicare has denied from "D" to "F" for reimbursement.

3. Tamara Toney
   Posted 7 months ago #
   

   We received each of these specimens from the surgeon. We received the lump and then also sections around the lump. Would that make a difference in coding?

4. Nikhil Nariani
   Posted 7 months ago #
   

   No, the coding rules would not allow us code separately

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