bwmartin
New
Ok Coding Community. I need your help.
My docs, who are Mohs surgeons, do biopsies here in our office and then process them via frozen section. Sometimes the results are available before a patient leaves the office, sometimes they are not. Just depends on how busy the lab is at the time and the length of a patient's appointment. I recently received audit results from a patient's DOS that included mohs and additional biopsies. The additional biopsies were processed by frozen section. The audit even states that there is documentation supporting that frozen section was performed. However, they are denying code 88331 and saying we should be billing 88305 because there is no documentation stating that the patient received the results at the time of the visit and 88331 was for intraoperative consultation and the following two features must be present to bill: "clinical formal request for intraoperative consultation and written pathologist's report." Then they go on to say that because our documentation says "patient will be notified of biopsy results, but instructed to call in two weeks if not contacted" that it does not validate that the results were given to the patient at the time of the encounter.
This is the first time I have ever received such a denial. I know we can bill frozen sections on biopsies of lesions not related to Mohs on the same DOS using the -59 on the biopsies and 88331. My docs also bill 88331 for any biopsies they process here in the office during skin checks, etc. Can someone explain to me the difference between 88331 and 88305? We were under the impression that 88305 was billed by a pathologist that does permanent sections not frozen and that when we process the specimens here in the office those are considered frozen. Should we be billing 88305 and not 88331 when we process our own specimens from a skin check but 88331 when we do biopsies on the same date as a Mohs surgery if and only if the results are given to the patient prior to them leaving the office.
Hope you all can follow all that!!
My docs, who are Mohs surgeons, do biopsies here in our office and then process them via frozen section. Sometimes the results are available before a patient leaves the office, sometimes they are not. Just depends on how busy the lab is at the time and the length of a patient's appointment. I recently received audit results from a patient's DOS that included mohs and additional biopsies. The additional biopsies were processed by frozen section. The audit even states that there is documentation supporting that frozen section was performed. However, they are denying code 88331 and saying we should be billing 88305 because there is no documentation stating that the patient received the results at the time of the visit and 88331 was for intraoperative consultation and the following two features must be present to bill: "clinical formal request for intraoperative consultation and written pathologist's report." Then they go on to say that because our documentation says "patient will be notified of biopsy results, but instructed to call in two weeks if not contacted" that it does not validate that the results were given to the patient at the time of the encounter.
This is the first time I have ever received such a denial. I know we can bill frozen sections on biopsies of lesions not related to Mohs on the same DOS using the -59 on the biopsies and 88331. My docs also bill 88331 for any biopsies they process here in the office during skin checks, etc. Can someone explain to me the difference between 88331 and 88305? We were under the impression that 88305 was billed by a pathologist that does permanent sections not frozen and that when we process the specimens here in the office those are considered frozen. Should we be billing 88305 and not 88331 when we process our own specimens from a skin check but 88331 when we do biopsies on the same date as a Mohs surgery if and only if the results are given to the patient prior to them leaving the office.
Hope you all can follow all that!!