rpmbilling
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I have a provider who performed Moh's surgery on a patient (17311 & 17312). While looking through the frozen sections he noticed some odd cells and decided to have a section of tissue put into a permanent section & sent out for further evaluation (like he normally does for a biopsy/excision). Now the insurance (UHC AARP Medicare Complete) is denying the Moh's citing their Moh's Micrographic Surgical policy. I explained that reimbursement on the Moh's surgery requires him to do all surgical and pathology on the specimen. He is pushing back stating special circumstances where he performed the frozen block pathology in the office along with the surgery, but also needed further pathology from an outside lab. Have you ever seen the provider get paid for the Moh's in a "special" situation like this? I've been searching for days and can't find anything that would allow this special circumstance. Thanks so much!