Trisha Posted Tue 04th of February, 2014 16:16:25 PM
In a dermpath lab when we receive a specimen that is in seperate vials, labeled on the requisition as:
A:Right cheek, 12- 6 o'clock
B:Right cheek, 3-6 o'clock
C:Right cheek, 6-9 o'clock
We bill 88305 x 3, Correct?
Scenario, it is medicare and pathologists orders stains on each.
G0461 x1 and G0462 x 2 (76 mod)
Also, one scenario this is from an outside group?
The other scenrario is that it is from a mohs surgeon within our department/group?
Is that correct? If not please guide me to guidelines I can refer to.
SuperCoder Answered Thu 06th of February, 2014 18:25:49 PM
There are three separate questions here, so let’s address them one at a time.
1. Although your method of distinguishing the cheek specimens is unfamiliar, the fact that they are separately labeled and in separate containers and separately evaluated and reported by the pathologist means that you can bill one unit of 88305 for each distinct skin biopsy specimen (not cyst, tag, debridement, plastic repair).
2. It’s not clear if you’re doing one qualitative antibody stain on each of three specimens, or if you’re doing three distinct antibody stains on one specimen. For one qualitative IHS stain on each of three specimens, bill three units of G0461 to Medicare. For three different (separate vials, separate slides) qualitative IHS stains on one specimen, bill G0461 and G0462 x 2 to Medicare. You shouldn’t need modifier 76 (unless a payer specifically requests it in this scenario).
3. For Mohs surgery, you should report codes in the range 17311-17315. These services include the surgery and the pathology, by definition. You should not additionally report 88305 (for the pathology) with these codes.