Wiki Checking margins

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jperkins

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I billed 88305 for dermatopathology which revealed lentigo maligna. About a week after, we received a specimen from the same patient with a request to check margins and we billed 88305 again. Medicare is denying bundling it to the first claim submitted. Is there guidelines or literature somewhere that says Medicare cannot be billed when checking margins for malignancy? I can't find anything so if anyone can point me in the right direction it will be greatly appreciated.
 
If it is a different specimen, then it should be paid, but you would need to indicate this with a modifier. If you’re just billing the same CPT again then of course the payer would have no way of knowing that it’s not a duplicate or that it’s unrelated to the previously paid service.
 
No, oh goodness, maybe you didn't review the entire post but this is what I am reading from this post thomas7331
First specimen was lets say February 1, 2029 with lentigo maligna billing 88305
Second specimen was lets say February 6, 2029 (less than a week) for a pathology charge billing 88305
This in my opinion does not need a modifier - clearly different DOS (date of service)
So may I ask jperkins a few questions?
Are we sure that the encounters are correct? I don't have access to the ORUs or DFTs.
Someone in billing or accessioning being hasty and assigning a prior case number or CSN or encounter to something that was already billed and pulling the wrong DOS (date of service) onto the claim creating a duplicate denial instead of properly creating a new encounter for the patient's second visit?
No, do not add a modifier to just get it paid. They are completely bundling this because they believe it all happened on the same DOS and you need to figure out why and how to fix it. Don't get me wrong Medicare can be a pain in the butt sometimes processing claims, but working denials I would have checked the areas I described for a fix before calling them to state they are wrong and exactly why.
Thank you for listening and am hopeful my suggestions may shed light on this.
Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT
 
Thank you. Have checked with the personnel who prepare our specimens for the dermatopathologist. The second specimen was given a different encounter and accession number and processed on the date it was received.
 
Hello jperkins,
You are so welcome; I am so incredibly pleased that you were able to identify the area that needed some assistance. Congratulations!!
Again, congratulations!
Fingers crossed that things go smoothly now for you and these two different claims.
Have a wonderful evening,
Dana
 
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