Insurance denying pathology for shave removals (113XX)

nkrush12

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Hi all,

I recently received an upheld denial from Health Partners insurance (Minnesota) indicating that we cannot bill pathology with shave removals. Per insurance claim coding committee, 2019 CPT Changes, An Insider's View states rationale for the shave removal codes (11300-11313) and the tangential codes (11102-11103) that states: "Histopathologic evaluation is incidental to the removal". Histopathologic evaluation, when submitted by the same operating physician, is included in the primary procedure.

I included copies of the 2019 CPT book, page 80 which states that during certain surgical procedures (such as shave removals) the removed tissue is often submitted for pathological examination. The obtaining of tissue for pathology during the course of these procedures is a routine component of such procedures. This obtaining of tissue is not considered a separate biopsy procedure and is not reported separately.

I read this as not being able to bill 113XX plus a biopsy code for the same lesion but we should be able to bill for our technical component of of the pathology (we have our own pathology lab, we contract with a pathologist to do readings and bill the professional component)

Any suggestions?

Nicole Lucas, CPC
 
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