Wiki Medicare Denial of 88305 when billed with an unrelated MOHS

[TrinaJKGarcia]

We are a dermatology practice with a doctor that specializes in MOHS (and is a histophathologist). We also employ ARNP's who will occasionally do excisions of skin cancers on the same day a MOHS is performed, which results in an 88305 charge. The pathology is read by our doctor-the histopathologist--who is also the one who would have performed the MOHS. We have avoided denials in the past by placing a 59 modifier on the 88305 to indicated it was for a separate procedure. Medicare is now denying the 88305 and have afforded no appeal rights. Has anyone else encountered this and have a solution? Medicare tells us that this is a new edit and they do not have a publication out yet. Is it appropriate to bill the 88305 on the day he reads the slide instead of the day of the biopsy? We did try to bill it using the XS modifier for Medicare instead of the 59 today, so we will find out of that is the trick soon! Any help would be appreciated!

 

[Texascoder64]

If the Mohs surgeon did a frozen section pathology reading (during the same session as the Mohs surgery) 88331 is billed along with the biopsy code. Was that the scenario? DOS is always the same date of collection.

 

[kristinemarie]

Cabana has LCD Article 52811

I am new to derm and found this situation as well. I was directed to LCD Article 52811. This is Cahaba states.
You should beable to Google this, and Get it that way. Good Luck!

 

[eugenia]

88305

Medicare has cut back on payments for pathology and surgical bundling issues. Try checking your local carrier LCDs to see what icd-10cm codes are accepted for the services performed by your providers. I have access to the Medicare website on my favorites at work. Maybe someone else has the website address for you to check for medical necessity criteria for the services rendered. Just coding for the cancer is not enough...what is the reason for the visit/services...pain...change in size of the mass...etc... I hope this helps you.
In 2016, modifier -59 is acceptable by Medicare when there is not a more appropriate X series modifier which can be downloaded from the Medicare Learning Network.