MOHs surgery and BX different site practices.

Brandy0618

Networker
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Mingus, TX
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If a MOHs surgeon performs surgery on a site that has been previously confirmed BCC or SCC (from dermatologist/dermatopathologist in the practice) and during this surgery he decides a separate site needs to be biopsied and sends this specimen to an outside lab, is this billable to the MOHS surgeon? If so, will he be able to receive payment? Or, will the carrier bundle regardless of modifier XS or 59. In addition, he has stated that he will not charge for the separate biopsy. Correct me if I am wrong, but this is violating the contract you have with your carriers that state you will submit all billable services to carrier. If you are the MOHs surgeon and you perform the additional biopsy, are you not required to perform the lab services on that biopsy? Or , is he able to send the specimen to an outside lab? I am so confused. Please help me understand the legal practices with MOHS surgery on the same day that a separate biopsy on a separate site is removed. Thank you.
 

thomas7331

True Blue
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If a MOHs surgeon performs surgery on a site that has been previously confirmed BCC or SCC (from dermatologist/dermatopathologist in the practice) and during this surgery he decides a separate site needs to be biopsied and sends this specimen to an outside lab, is this billable to the MOHS surgeon? If so, will he be able to receive payment? Or, will the carrier bundle regardless of modifier XS or 59. In addition, he has stated that he will not charge for the separate biopsy. Correct me if I am wrong, but this is violating the contract you have with your carriers that state you will submit all billable services to carrier. If you are the MOHs surgeon and you perform the additional biopsy, are you not required to perform the lab services on that biopsy? Or , is he able to send the specimen to an outside lab? I am so confused. Please help me understand the legal practices with MOHS surgery on the same day that a separate biopsy on a separate site is removed. Thank you.
Yes, the surgeon can bill for the biopsy or biopsies of separate sites that are unrelated to the Mohs procedure. The modifiers to unbundle these would be appropriate in this situation and carriers should allow for separate payment. The provider is not required to perform the pathology on the biopsy specimen - pathology is a component of the Mohs procedure, but not of the biopsy. It is common for Mohs provider to send out their biopsies to a lab because they may not have the resources to do all of their biopsies in-house in addition to their Mohs pathology, so it may be more cost-effective to let a lab do them. There shouldn't be any concern about this.

As for not charging for the biopsy - that isn't really a compliant practice, though there may be a valid reason for it under special circumstances. The OIG has indicated that providers may not give Medicare beneficiaries free goods or services of value as they may consider this an illegal 'inducement' to the patient. As to whether or not a commercial payer contract requires the billing of services, you would have to review your specific contract to determine the answer to that question. In reality, though, most payers would probably prefer that the provider bill them fewer services rather than more so are unlikely to complain about it - they're more concerned with preventing overpayments than they are underpayments.
 

Brandy0618

Networker
Messages
68
Location
Mingus, TX
Best answers
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Yes, the surgeon can bill for the biopsy or biopsies of separate sites that are unrelated to the Mohs procedure. The modifiers to unbundle these would be appropriate in this situation and carriers should allow for separate payment. The provider is not required to perform the pathology on the biopsy specimen - pathology is a component of the Mohs procedure, but not of the biopsy. It is common for Mohs provider to send out their biopsies to a lab because they may not have the resources to do all of their biopsies in-house in addition to their Mohs pathology, so it may be more cost-effective to let a lab do them. There shouldn't be any concern about this.

As for not charging for the biopsy - that isn't really a compliant practice, though there may be a valid reason for it under special circumstances. The OIG has indicated that providers may not give Medicare beneficiaries free goods or services of value as they may consider this an illegal 'inducement' to the patient. As to whether or not a commercial payer contract requires the billing of services, you would have to review your specific contract to determine the answer to that question. In reality, though, most payers would probably prefer that the provider bill them fewer services rather than more so are unlikely to complain about it - they're more concerned with preventing overpayments than they are und
 
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