bwmartin

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Hello,

I need help with understanding this code (88323). We are trying to send a "wet" specimen/slides from Mohs to a pathologist for a consultation to check for Perineural Invasion. We have cleared the skin cancer but do not have the necessary permanent/special staining to check for PNI here in the office. We think they should be billing 88323 but they are billing 88305 which is causing us to have to pay back our Mohs payment because you cannot bill Mohs and 88305 on the same date of service for the same specimen. The pathologist says that the "referred material" has to be in wax/received as a block, that it cannot be "wet." However, CPT does not state wet vs wax. Is there anyone out there that can help me understand why it would matter how the specimen is received as to whether the pathologist would bill a consult vs 88305? Any help would be appreciated.

Brandy
 

bbooks

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Padget has an example specific to this situation in his handbook. Due to copyright, I can't quote the example, but he says that the pathologist should bill 88323 rather than 88305, as long as the dermatologist has already examined and diagnosed at least part of the lesion. The fact that it is fresh tissue makes no difference.
 

Whitney

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Hello,

I have a scenario that our dermatopathologist is only billing the technical component on a specimen that he sends out for an expert opinion. He did the professional component, but wants an expert opinion. The expert lab is billing the consultation codes 88321 and 88323.

Who is Padget, because this may answer my question.

Thanks so much for your help.
 

bbooks

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If your dermatopathologist has done the professional component, including a full report, then he/she can also charge the professional component, and your expert lab can charge for the consult.

Padget is the gentleman who wrote "Pathology Service Coding Handbook." The handbook was bought by American Pathology Foundation and is now available on a subscription basis through their web site: https://www.apfconnect.org/pathology-service-coding-handbook.php. Mr Padget retired last year and the editor of the book is now Brenda Cox. This is a very useful resource. I couldn't do without it. The subscription includes 6 consults with Brenda Cox.
 
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