Vaida Posted Mon 12th of October, 2015 14:33:43 PM
Hi. We started getting denials from Medicare (FL) for CPT 88331 billed on the same day as MOHS surgery and skin biopsy, which is usually performed to confirm the diagnosis. Here is one of the most recent denials:
Medicare denied the 88331 for:
"The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present"
"Not paid to practitioner when provided to patient in this place of service. Payment included in the reimbursement issued the facility".
Do we code these cases when lesion is biopsied prior to MOHS to confirm diagnosis incorrectly or there is some new rule reg. this that maybe we are not aware of..? Your input will be appreciated.
SuperCoder Answered Tue 13th of October, 2015 05:59:44 AM
NCCI states that "Mohs micrographic surgery (CPT codes 17311-17315) is performed to remove complex or ill-defined cutaneous malignancy. A single physician performs both the surgery and pathologic examination of the specimen(s). The Mohs micrographic surgery CPT codes include skin biopsy and excision services (CPT codes 11100-11101, 11600-11646, and 17260-17286) and pathology services (88300-88309, 88329-88332). Reporting these latter codes in addition to the Mohs micrographic surgery CPT codes is inappropriate". On the other hand, if pathology consultation has been performed with CPT 11100 to confirm the diagnosis then you can bill 88331 with 59 modifier. It is suggestible to appeal Medicare with proper explained documentation. Hope it helps!