# Excision with Frozen Sections



## lindalou0259 (Jul 25, 2011)

We are considering the possibility of utilizing a local mobile Pathology Lab that would perform onsite frozen section review.  My question is, if the initial excision does not provide clear margins would we submit both original excision and additional excision with a 78 modifier or up the code to a larger excision?


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## Jen Verlinda (Jul 26, 2011)

Let's say the initial excision had a excised diameter of 1.1 cm, and the second piece of tissue was excised measuring 6.0 mm, you would add the two (1.1 + 0.6) and bill the final excised diameter of the lesion, 1.7. For Path 88331, 88332.

Jen Verlinda, CPC


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## mitchellde (Jul 26, 2011)

Jen Verlinda said:


> Let's say the initial excision had a excised diameter of 1.1 cm, and the second piece of tissue was excised measuring 6.0 mm, you would add the two (1.1 + 0.6) and bill the final excised diameter of the lesion, 1.7. For Path 88331, 88332.
> 
> Jen Verlinda, CPC



No I disagree, if the physician performs an excision and then leaves the patient to set while he runs a frozen section, then the re-excision meets the criteria for a staged procedure, it was discussed with the patient ahead of time and it is more extensive, so bill the second excision with a 58 modifier, this is how we did these at the cancer center all the time.. You need two op notes to support this.


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## Jen Verlinda (Jul 27, 2011)

That's not the case, actually. I just attended the Pacific Northwest Dermatological Conference on July 22-24, which was hosted by Inga Ellzey, and I quoted Inga's example specifically when I replied to this post. This was a great topic of discussion, among many other great Derm scenarios. So Per the "Guru" herself, that is proper billing. This scenario would not qualify as "stages".


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## armen (Jul 27, 2011)

Jen Verlinda said:


> That's not the case, actually. I just attended the Pacific Northwest Dermatological Conference on July 22-24, which was hosted by Inga Ellzey, and I quoted Inga's example specifically when I replied to this post. This was a great topic of discussion, among many other great Derm scenarios. So Per the "Guru" herself, that is proper billing. This scenario would not qualify as "stages".



I think both Jen Verlinda & mitchellde are right. 

Per CPT,  when frozen section pathology shows the margins of excision were not adequate an additional excision may be necessary for complete tumor removal. Use only one code to report the additional excision and re-excision(s) based on the final widest excised diameter required for complete tumor removal at the same operative session. To report a re-excision procedure performed to widen margins at a subsequent operative session, see codes 11600-11646, as appropriate. Append modifier 58 if the re-excision procedure is performed during the postoperative period of the primary excision procedure.


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