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Medicare Recoup. on Mohs

  1. #1
    Default Medicare Recoup. on Mohs
    Medical Coding Books
    I was wondering if any could me some direction regarding a Medicare take back from 2009. We billed for a Mohs procedure and sent paths for special stains. The Pathologists billed for global services and is causing our claims to audited for refund.
    Some reconsiderations have been performed and found not in our favor, which is odd since we did the Mohs.

    Has anyone had this issue or any advice on what we should do. My doctor does not want to the next level of appeal with Medicare.

    Thank you in advance.

    Beth.

  2. #2
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    Columbia, MO
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    if you sent the specimens out for path instead of performing the special stains yourself then it is not a Mohs procedure, what makes a MOHs unique is that the physician is the surgeon and the pathologist at the same time.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Columbia, MO
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    Quote Originally Posted by bmanus View Post
    I was wondering if any could me some direction regarding a Medicare take back from 2009. We billed for a Mohs procedure and sent paths for special stains. The Pathologists billed for global services and is causing our claims to audited for refund.
    Some reconsiderations have been performed and found not in our favor, which is odd since we did the Mohs.

    Has anyone had this issue or any advice on what we should do. My doctor does not want to the next level of appeal with Medicare.

    Thank you in advance.

    Beth.
    I thought you would be interested in this it is an excerpt from an article published in the ADAMA newsletter, Executive decisions in Dermatology
    Mohs' Micrographic Surgery (MMS) is a surgical
    technique of excising skin cancer where thin layers
    of skin are surgically removed and the specimen
    is processed immediately. For this technique the
    surgeon must act in two distinct roles: first as a
    surgeon and second as a pathologist. The operative
    note and pathology documentation in the patient's
    medical record should show clearly that MMS was
    performed using this accepted Mohs technique. If
    either part of the procedure is delegated to another
    physician, such as delegating the pathology to
    a different physician, the surgery should not be
    reported as a MMS technique. The pathology
    reports must be included in the clinical record to
    indicate a histopathologic type, such as a basal or
    squamous cell type. The goal of the Mohs surgery
    is to remove the cancer cells completely while
    preserving a maximum amount of healthy tissue.

    The work of processing and interpretation of one
    routine stain is included in the reimbursement
    for codes 17311 through 17315. This stain is
    usually hematoxylin and eosin, or toluidine
    blue. If other special stains are necessary after
    one routine stain, the appropriate code for
    special stains (88312-88314) may be reported,
    as may immunoperoxidase stains (88342), or
    decalcification procedures (88311). When a nonroutine
    histochemical stain on frozen tissue is
    utilized, report 88314 with modifier 59 Distinct
    procedural service attached. Special stains are
    used infrequently in most practices.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
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    Debra,
    We did the Mohs and our pathology but we did send several out for special stains and the lab billed for the special stains I'm guessing without any modifiers. Since we did our full procedure we should be able to do bill for the Mohs, correct?

    Thank you for your help.
    Beth Manus CPC

  5. #5
    Location
    Columbia, MO
    Posts
    12,531
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    once you sent the specimens out for special stains it ceased to be a Mohs by definition.

    Debra A. Mitchell, MSPH, CPC-H

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