Wiki Medicare Denial of 88305

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TrinaJKGarcia

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We are a dermatology office whose doctor is a certified dermatopathologist as well. He can perform MOHS. We have come across a new issue with Medicare when billing MOHS and a separate pathology on the same day. Here is an example: Patient comes in and has MOHS done on the arm by the doctor. The patient also has a separate excision performed on the face by one of our ARNP's, that excision requires a pathology to be billed. So we bill for the MOHS, the MOHS closure, then the excision and closure of the other lesion and the pathology--that is done by the Dr who performed the MOHS. We have in the past been able to add a 59 modifier to the 88305 indicating that it is separate than the MOHS, but now Medicare is denying the 88305 still. Anyone encounter this, or have any information?
 
MOHS on arm with separate lesion on face

Hi TrinaJKGarcia
Who is billing the claim for the excision on the face? "The patient also has a separate excision performed on the face by one of our ARNPs" - who is billing this? Working denials I already am assuming because the MOHs was done that no separate reimbursement will be made for a pathology charge. You will have to appeal. Be very specific on your appeal that the pathology did not result because of the MOHs procedure. Send the path report and be VERY specific this was for XXXX lesion from patient's FACE and had nothing to do with XXXXXX procedure done on the ARM.
Hopefully this helps,
Dana Chock, CPC, CCA, CANPC, CHONC, CPMA, CPB
Anesthesia, Pathology, & Laboratory Coder
 
88305 denying with 59 modifier

We are also having the same issue with the NGS Medicare carrier denying the pathology code 88305 with a 59 modifier when billed together with Mohs. They are splitting off this code from the Mohs and denying it as not separately payable. The worst thing about this is that they are not giving us appeal rights on this denial so we are are not sure what to do so we can actually appeal it. The provider reps at Medicare were not helpful at all and could not point to the reason why this is happening. We are going to try and see if we drop the modifier if it actually denies in a way that gives us appeal rights. I know this isn't correct, but I need to be able to appeal these. We also had a RAC audit on this combination a few months ago where they took back the money on the pathology code and after we appealed with letters from the doctor, they reimbursed the money back. This is beyond frustrating. I would also appreciate any assistance or suggestions on this.


TrinaJKGarcia said:
We are a dermatology office whose doctor is a certified dermatopathologist as well. He can perform MOHS. We have come across a new issue with Medicare when billing MOHS and a separate pathology on the same day. Here is an example: Patient comes in and has MOHS done on the arm by the doctor. The patient also has a separate excision performed on the face by one of our ARNP's, that excision requires a pathology to be billed. So we bill for the MOHS, the MOHS closure, then the excision and closure of the other lesion and the pathology--that is done by the Dr who performed the MOHS. We have in the past been able to add a 59 modifier to the 88305 indicating that it is separate than the MOHS, but now Medicare is denying the 88305 still. Anyone encounter this, or have any information?
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I am the kindest pathology coder you will ever meet. Did you even review your post? Take a moment, breath and re-read your post please okay now.
 
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