[Histonet] Billing IHC on MOHS

[Kim Donadio]

Carol, 
           I obvioulsy have a talent for getting involved in controversial subjects, I really got to stop that LOL 
 
I used to have a CPT manual but no longer,they are very handy. If you got it out of that it seems to me thats the golden rule. My concern for you was that they recently changed how many you could bill per site. We had great discussion on it here. As I am not familiar with 88314 and got little info when I tried to look it up, coder wanted 20 bucks from me to see it. I am aware that Mohs has some codes specifically for Mohs, but my understanding is that CPT's are universal and each antibody would be 88342. However if your cpt manual says specifically a Mohs fs + antibody is 88314 I can only imagine the reimbursment for the frozen is included? I cant imagine why they would have a seperate one. Also when I was looking at what little coder would let me see for 88314, the termonology caught my eye. When I think histochemical stain , I think stains like a iron or trichrome or something of that nature. Thats why I mentioned 88342 because its specifically for
 immunohistochemistry, each antibody. 
 
Well, I hope I havnt made this clear as mud. I have no perfect answer just my thoughts. I am eager to hear what AAD says so keep us up to date. 
 
Thanks
 
Kim D
 

________________________________
 From: Carol Torrence <ctorrence <@t> kmcpa.com>
To: 'Kim Donadio' <one_angel_secret <@t> yahoo.com> 
Cc: "'Weems, Joyce K.'" <Joyce.Weems <@t> emoryhealthcare.org>; 'Ingles Claire' <CIngles <@t> uwhealth.org>; histonet <@t> lists.utsouthwestern.edu 
Sent: Monday, June 18, 2012 5:23 PM
Subject: RE: [Histonet] Billing IHC on MOHS
  
Thanks everyone.  
I quoted the description straight from the PMIC coding manual.  It is for
use with 17311-17315, 88302-88309, 33221, and 88332.  I was hoping to get a
discussion about Mohs mysteries.  I have also found it in two other
publications. Mohs Society referred me AAD and I am waiting for an email
response.

After reviewing the slides that were given to our lab for staining I
discovered that all five slides were from a single block containing two
margins on each slide.  I charged 88314-59.

Kim you bring up another often controversial subject...when to charge 88307
or 88309. I became a CPC in 2005 but have found that if "you don't use you
lose it and if not....they will change the rules on you anyway".  Ha!

I appreciate all comment. 
Carol T 

-----Original Message-----
From: Kim Donadio [mailto:one_angel_secret <@t> yahoo.com] 
Sent: Saturday, June 16, 2012 10:40 AM
To: Carol Torrence
Cc: Weems, Joyce K.; Ingles Claire; <histonet <@t> lists.utsouthwestern.edu>
Subject: Re: [Histonet] Billing IHC on MOHS

I'd be very careful with this. Histochemical even if it's on frozen section
such as 88314 does not mean immunohistochemical which is 88342 to my
understanding. To my understanding anytime you use a antibody it's a 88342
code. Now as far as being able to code for each margin say from 3-6 or 6-9
o'clock etc that seems like it would fall under the rules for each site to
me kind of like we would charge a 88307 or 88309 for excision with margins
instead of a 88305 which pays less. I personally recommend this not be left
in the hands of google or even histonet. Good information comes from both
but you might just want to put a call into American society of MOHs and ask.
Because over billing is serious business and can get you in a lot of
trouble. I only say this because usually in MOHs you'll get the whole
specimen which your checking for margins. Then any piece after that would be
a separate specimen example that would be part " B " which you could charge
separate for.  And since different docs do this differently making a call
couldn't hurt then you could come and share what they say with us :) 

Sent from my iPhone

On Jun 15, 2012, at 2:20 PM, "Carol Torrence" <ctorrence <@t> kmcpa.com> wrote:

> By George I've got it! This is what I read from "Coder's Choice CPT Plus"
> 
> 88314 is for IHC performed on frozen tissue.......when a nonroutine 
> histochemical stain on frozen tissue during Mohs surgery is utilized, 
> report
> 88314 with modifier 59.  Report one unit of 88314 for each special 
> stain on each frozen surgical pathology block.
> 
> Carol M. Torrence, HT(ASCP)CM
> Director of Laboratory Services
> KMC Dermatology - Pathology
> 2921 SW Wanamaker Dr.
> Topeka, Kansas 66614-5334
> 785-273-2788 ext 328
> fax 785-272-6185
> ctorrence <@t> kmcpa.com
> 
> 
> 
> 
> 
> 
> 
> 
> 
> 
> 
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