Pathology/Lab Coding Alert

Question: We have a dermatology clinic client who sometimes sends our pathologist slides from a Mohs procedure for interpretation. Can we bill this service?

Nebraska Subscriber

Answer: You cannot bill a pathology exam code such as 88305 (Level IV - Surgical pathology, gross and microscopic examination … skin, other than cyst/tag/debridement/plastic repair …) in addition to a Mohs code such as 17311 (Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), head, neck, hands, feet, genitalia, or any location with surgery directly involving muscle, cartilage, bone, tendon, major nerves, or vessels; first stage, up to 5 tissue blocks) for the same procedure.

Remember that the Mohs surgeon microscopically examines the tissue as part of that procedure, so having a separate pathologist evaluate the same tissue as part of the service is “double dipping.” The National Correct Coding Initiative (NCCI) edits bundles 88305 as a column 2 code with the Mohs codes for that reason.

On the other hand, if the dermatologist is requesting a consultation from your pathologist, you may be able to bill the service. Remember that to bill a pathology consultation, you must have a request from the referring “outside” physician, and the pathologist must render a medical opinion and write a report.

If the dermatologist requests a consult on Mohs slides, you could code 88321 (Consultation and report on referred slides prepared elsewhere) for the service. Unlike 88305, you won’t face an NCCI edit for reporting Mohs with a surgical pathology consultation.