Trisha Posted Thu 07th of March, 2013 14:36:11 PM
This is a Dermatopathology lab. We have a (in-house) Mohs surgeon who is part of our department but his Mohs lab has a separate CLIA number who sometimes submits specimens for confirmation of diagnosis or concern of perinerual spread.
How do I know for sure by the details on the ordering requisition when it is appropriate to bill 88305 or 88323 or???? what to bill? I am not sure.
Here are a few scenarios to hopefully help:
Lab receives fresh tissue: below is the order
From mohs req: pt with BCNS and since last visit developed an large painful new tumor, biopsy done today and frozen section diag is BCC. Submitted for: confirmation of diagnosis
Or another patients note:
Orig bx equivocal diag with differential BCC vs poorly differentiated SCC, mohs was done today and BCC was seen, the debulk and stage 1 specimen are submitted in one block to assist with confirming the BCC diagnosis.
What does the Dermpath lab bill for the reading?? 88305..is it an 88323? Neither? All we have is the order like examples above.
Thank you for any and all guidance you may provide
SuperCoder Answered Tue 12th of March, 2013 12:38:28 PM
You need to consider the following four items to answer your question:
1. You cannot use the outside consultation codes such as 88323 (Consultation and report on referred material requiring preparation of slides), which you asked about. Because you stated that the Mohs surgeon is part of your department, using the codes for consultation on referred slides or material (88321-88325) would not be appropriate under any circumstances.
2. The surgeon should use the Mohs codes 17311-+17315 (Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain[s] [e.g., hematoxylin and eosin, toluidine blue] …) only when he acts as both the surgeon and the pathologist. Based on your description of the situation, the surgeon would be using his own lab in those cases, and the service would not involve your lab billing anything.
3. If the surgeon removes tissue and sends it to your lab, he should bill lesion excision (such as 11643, Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1 to 3.0 cm) not Mohs. And you should bill the appropriate surgical pathology code such as 88305 (Level IV - Surgical pathology, gross and microscopic examination, Skin, other than cyst/tag/debridement/plastic repair) or 88331 (Pathology consultation during surgery; first tissue block, with frozen section[s], single specimen).
4. If the surgeon performs Mohs and sends your lab part of the excised tissue for “confirmation,” you cannot additionally bill a surgical pathology code such as 88305 or 88331. Correct Coding Initiative (CCI) edits are in place to prevent billing both services, which amounts to billing the pathology twice. You can override the edits with modifier 59 (Distinct procedural service) in some circumstances, such as if the surgeon removes a biopsy and requests your diagnosis before performing Mohs. In that case, your 88331 and/or 88305 service is for a biopsy, and the surgeon performs his own pathology on the Mohs excisions.
So in your first example, your lab can bill 88331 and 88305 and the surgeon will bill a biopsy code, because he doesn’t perform Mohs on that date.
In your second example, your lab cannot bill anything, because the surgeon performs the pathology on the Mohs specimen.