Help! Want to know other opinions on what dx for immunopathology...

mlriggan

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I have an 88350 with the current diagnosis of L30.8, which is hitting the CCI edit.
In reviewing this, we have different opinions on what diagnosis can be coded.

The path report states, "Direct immunofluorescence studies are performed on frozen sections of skin biopsy using the listed panel of antibodies. There is linear marking for IgG(0-1+) and C3(3+) along the dermal-epidermal junction. No IgM, IgA, or fibrinogen is identified.
These findings support a diagnosis of bullous pemphigoid, although epidermolysis bullosa acquisita (EBA) cannot be completely excluded. Indirect immunofluorescence studies using the patients serum are recommended to confirm the diagnosis."

One opinion is that the dx should be the L30.8 due to the wording "although epidermolysis bullosa acquisita (EBA) cannot be completely excluded." The other opinion is that the bullous pemphigoid, L12.0 should be able to be coded because of the statement, "These findings support a diagnosis of bullous pemphigoid."

Any info/opinions would be greatly appreciated!

Thank you, Meggan
 

irishhawk

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I have an 88350 with the current diagnosis of L30.8, which is hitting the CCI edit.
In reviewing this, we have different opinions on what diagnosis can be coded.

The path report states, "Direct immunofluorescence studies are performed on frozen sections of skin biopsy using the listed panel of antibodies. There is linear marking for IgG(0-1+) and C3(3+) along the dermal-epidermal junction. No IgM, IgA, or fibrinogen is identified.
These findings support a diagnosis of bullous pemphigoid, although epidermolysis bullosa acquisita (EBA) cannot be completely excluded. Indirect immunofluorescence studies using the patients serum are recommended to confirm the diagnosis."

One opinion is that the dx should be the L30.8 due to the wording "although epidermolysis bullosa acquisita (EBA) cannot be completely excluded." The other opinion is that the bullous pemphigoid, L12.0 should be able to be coded because of the statement, "These findings support a diagnosis of bullous pemphigoid."

Any info/opinions would be greatly appreciated!

Thank you, Meggan


My two cents: 88346, +88350 each additional; and L12.0
 

mitchellde

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I would code the L12.0 also. In addition there are a total of 5 stains in your documentation so 88346 and 88350 with 4 units.
 

fuga

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Our office has recently started receiving Medicare denials for 88350 billed with more than 1-unit, even when documentation supports > 1-unit. On appeal Medicare has stated:

The documentation only supports one specimen. The unit of service for immunoflourescent antibody studies is each antibody staining procedure per specimen. If a single antibody staining procedure for one or more antibodies is performed on multiple blocks from a surgical specimen, multiple slides from a cytologic specimen, or multiple slides from a hematologic specimen, only one unit of service may be reported for each separate specimen. Physicians should not report more than one unit of service for an immunoflourescent antibody stain per specimen for an immunoflourescent antibody staining procedure even if it contains multiple separately interpretable antibodies.

Has anyone else experienced this? And are you in agreement with Medicare's interpretation?
 
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