I was wondering if any could me some direction regarding a Medicare take back from 2009. We billed for a Mohs procedure and sent paths for special stains. The Pathologists billed for global services and is causing our claims to audited for refund.
Some reconsiderations have been performed and found not in our favor, which is odd since we did the Mohs.
Has anyone had this issue or any advice on what we should do. My doctor does not want to the next level of appeal with Medicare.
Thank you in advance.
Beth.
I thought you would be interested in this it is an excerpt from an article published in the ADAMA newsletter, Executive decisions in Dermatology
Mohs' Micrographic Surgery (MMS) is a surgical
technique of excising skin cancer where thin layers
of skin are surgically removed and the specimen
is processed immediately. For this technique the
surgeon must act in two distinct roles: first as a
surgeon and second as a pathologist. The operative
note and pathology documentation in the patient's
medical record should show clearly that MMS was
performed using this accepted Mohs technique. If
either part of the procedure is delegated to another
physician, such as delegating the pathology to
a different physician, the surgery should not be
reported as a MMS technique. The pathology
reports must be included in the clinical record to
indicate a histopathologic type, such as a basal or
squamous cell type. The goal of the Mohs surgery
is to remove the cancer cells completely while
preserving a maximum amount of healthy tissue.
The work of processing and interpretation of one
routine stain is included in the reimbursement
for codes 17311 through 17315. This stain is
usually hematoxylin and eosin, or toluidine
blue. If other special stains are necessary after
one routine stain, the appropriate code for
special stains (88312-88314) may be reported,
as may immunoperoxidase stains (88342), or
decalcification procedures (88311). When a nonroutine
histochemical stain on frozen tissue is
utilized, report 88314 with modifier 59 Distinct
procedural service attached. Special stains are
used infrequently in most practices.
