Wiki Mole removal on patient's entire body

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debneas

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We have a patient who would like every mole on his entire body removed. He just doesn't want them there and has a family history of melanoma (father). The physician does not think any are clinically suspicious, but whatever he removes must be sent for pathology. How can this be justified?
 
It can't be. It is cosmetic. Just because there is family hx of melanoma does not justify removing all of them. The provider does not see anything suspicious either. This goes down as cosmetic.
 
We talked about that, but will there be a problem sending a cosmetic lesion for pathology? The physician will still want to send for pathology.
 
No there should be no problem.. Use the V code for cosmetic and the V code for family history. However be certain the payient agrees to any path charges as those will also be patient responsibility. If the patient refuses the path and you send it anyway then your provider will sit on that bill.
 
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the pathology lab will be billing the patients' insurance based on the findings of the pathologist. The provider removing the moles needs to bill the patient out of pocket and I would suggest having the patient sign a release. If the patient has Medicare they need to sign an ABN.
 
They will not bill the insurance if it is coded as cosmetic. This becomes a real sticky point as path charges are pricy. The patient must be informed that specimens will be submitted unless the patient declines. As long as the provider documents that this was discussed and declined, then the provider is covered.
 
keep in mind that even though a mole "looks normal" to a doctor, that does not mean that the dr is correct 100% of the time. Take my mother for example. She had a reoccurence of her melanoma on her leg. She went to her derm. He said "it looks normal, but it you REALLLLYYY want me to remove it and send it out to be read, I can." She said "yes." and guess what? It was melanoma. I see where you are coming from- a patient wants every single mole removed due to fam hx of mel and yet based on "clinical" standpoints if they exhibit no signs of irregularity and itching or catching on a necklace etc. that its a cosmetic procedure. I would think your provider will be sending the specimens out to be read? Because heaven forbid if at least one is + for skin cancer....
 
there are path labs like Pinkus that will give a discount for patients that have "no insurance"; they charge a flat fee for each specimen read.
 
I agree, however the patient is the one that gets to decide based on the information relayed by the physician. If the provider sends the specimen without telling the patient prior to the procedure that this is the intent. Then the patient is not liable to pay the bill. I have had cosmetic procedures. At no time was it discussed that specimens would go to path. I paid up front the total cost I was told it would be. Weeks later I received an enormous path bill that of course insurance would not cover as it was the result of a cosmetic procedure. I did refuse to pay and ultimately won the battle. Since that time I have been on the billing end and have instructed the providers to always include this discussion with the payient, the result ... No more blind sided patients!
 
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