88331 vs 88305

bwmartin

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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!!
 

jleavit2

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88331 = Frozen Section?

This is confusing for our Mohs surgeons too, and I wish I could find something definitive on it. The difference between 88331 and 88305 does not seem to be that one is a frozen section and the other is permanent. Based on the code descriptions, 88305 seems to be the correct code regardless of whether a frozen or permanent section is done. 88331 is used for a "pathology consultation during surgery". Mohs surgeons function in two capacities - surgeon and pathologist. CPT seems ok with the Mohs surgeons having bipolar type of "consultation during surgery" with themselves because they say to report 88331-59 when there is "no prior pathology confirmation of a diagnosis" and they have to biopsy on the same day.

In my mind the "during surgery" portion of the code description is the difference between 88305 and 88331. If, during the same visit, the doctor does a biopsy, pathology, and then a definitive procedure (mohs, excision, shave, destruction) then 88331. If the doctor does biopsy/excision/shave followed by pathology then I think 88305. Or, in other words, path done after the lesion is done being treated for the day = 88305. Path done while in the process of treating a lesion - 88331.
 

jennyaharvey

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All,
I'm confused by documentation requirements for 88331. My doc is performing Mohs on a lesion on the rt. temple, but notices a suspicious lesion on the patient's right wrist and states the following: "The specimen was submitted for frozen section as 1 block. The tissue specimen was frozen in the cryostat, sectioned and stained. Frozen section diagnosis is squamous cell carcinoma, right wrist." My doc performed a curettage and destruction on the wrist lesion on the same date as the Mohs on the patient's temple. Obviously, this is 2 separate sites, so we are good on that. She wants to bill for the frozen section with 88331, Pathology consultation during surgery; first tissue block, with frozen section(s), single specimen. Doesn't this require documentation of the three R's of a consultation?
 

bwmartin

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I don't think the 88331 "consultation" would be the same as an office visit consultation but I certainly could be wrong.
 

bwmartin

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88331 = Frozen Section?

This is confusing for our Mohs surgeons too, and I wish I could find something definitive on it. The difference between 88331 and 88305 does not seem to be that one is a frozen section and the other is permanent. Based on the code descriptions, 88305 seems to be the correct code regardless of whether a frozen or permanent section is done. 88331 is used for a "pathology consultation during surgery". Mohs surgeons function in two capacities - surgeon and pathologist. CPT seems ok with the Mohs surgeons having bipolar type of "consultation during surgery" with themselves because they say to report 88331-59 when there is "no prior pathology confirmation of a diagnosis" and they have to biopsy on the same day.

In my mind the "during surgery" portion of the code description is the difference between 88305 and 88331. If, during the same visit, the doctor does a biopsy, pathology, and then a definitive procedure (mohs, excision, shave, destruction) then 88331. If the doctor does biopsy/excision/shave followed by pathology then I think 88305. Or, in other words, path done after the lesion is done being treated for the day = 88305. Path done while in the process of treating a lesion - 88331.
Thank you. We decided to proceed with using 88305 for those that are not processed/patient notified within their visit. We are only using 88331 if the specimen is processed while the patient is present and notified within their visit.
 
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