Wiki Path Report Question

[andie.zurbrick]

We usually bill for Anesthesia and Pain but we have one doctor that we bill for who often does skin lesion removals, he is not an anesthesiologist. I am confused on the billing, or rather, I THINK I am right but can't find the documentation to show it. I would appreciate some help.

Here is the scenario:
Our surgeon takes a skin lesion sample and sends it to an outside path lab. The lab reviews the specimens, determines a diagnosis, sends a report back to our surgeon with the diagnosis codes attached. Our surgeon then discusses this report with the patient.

My gut tells me that the surgeon can NOT bill anything for this other than the E&M for the visit with the patient. My supervisor disagrees. I need something in writing that proves either case.

Any links would be helpful! Thanks so much.

 

[Pam Warren]

The surgeon can bill the lesion excision when he performs it....wait for the pathology before you code it, because the codes are different for excisions when they're benign vs. malignant. These codes are in the integumentary section of CPT.

If he sees the patient again, <10 days post-surgical, that E&M visit for the discussion of pathology is going to be bundled into the minor procedure. After 10 days, technically you can bill an E&M, but frankly, not many payers will cover it, since they still bundle it in.