[Histonet] Billing IHC on MOHS

[Kim Donadio]

The terminology is confusing< stage and per layer are not the same thing to me, depends on how you think about it >. Seems that Moh's and yes I have done this, can be done different. You have the Dr Mohs way of getting the what we call Donut specimen, which gets inked, nicked, embedded flat then frozen. This is your 1st stage. or block "A" if you will. Now some people will cut this into 2 pieces and even more and this creates more blocks. All of that first specimen is still the 1st stage and considered block A. You bill for block A, not for A1, A2 etc. and yes you are correct each additional stage( had to go back because 1st stage was positive) would be billiable again, same senario above. The second stage Block "B" billiable for "B" only, not B1, B2 etc. This was something we had much discussion about here as they recently changed multiple billing on the same site, or for Mohs you would call it Same Stage. This is my interpretation. 
 
and to make sure I am not mis-interpreting you, you're not considering every section as you mentioned a seperate stage? While I can see that Carol's post has (stage) next to per layer, I have to wonder if this is exactly out of the book? Because I would disagree with the two terms meaning the same as well.  Refer to above comment for my definition of Stage and hopfully it has clarity. :)
 
As far as ignoring Medicare, I would never suggest that. And for ignoring insurance companies, well you can try all they can do is deny payment and then you get to haggle with them. 
 
I'm not sure I can add anything else to this conversation so I will let the rest have at it for now. 
 
Hope everyone has a fantastic week! 
 
Kim D
 
 

________________________________
From: William Chappell <chapcl <@t> yahoo.com>
To: Kim Donadio <one_angel_secret <@t> yahoo.com> 
Cc: Carol Torrence <ctorrence <@t> kmcpa.com>; "histonet <@t> lists.utsouthwestern.edu" <histonet <@t> lists.utsouthwestern.edu>; 'Ingles Claire' <CIngles <@t> uwhealth.org> 
Sent: Tuesday, June 19, 2012 9:45 PM
Subject: Re: [Histonet] Billing IHC on MOHS

Well, I don't know if that settles that.

I haven't responded, because I have not worked for a Mohs dermatopahtologist who runs Immunos (I have worked at numerous Mohs laboratories), however, this explanation is contradictory.  "Each stain is reported only once per block, not per slide or per layer (stage)." Yet the definition of a block, "Tissue flattened by cutting into pieces, embedded, and frozen in mounting medium used by histotechnologists to embed tissue for frozen sections."  Every stage represent a new block in which slides are cut.  These two statements are contradictory and need clarification.

Now, my own opinion (again I have talked with my dermatopathologist and billing specialist and they are as lost as we) is that by definition, Mohs is a frozen section diagnosis that must be made by the surgeon (i.e., for a Mohs to be a mohs the surgeon removing the tissue must diagnose the tissue -- look it up).  Every section taken, at every stage is a separate block of the same case.  In the event you can charge immunos per case, only one charge can be made.  If it can be shown that immunos can be charged per block (per the definition below), every immuno on every block from every stage can be charged.

Now for the practicality -- we always start questions like this because medicare sets standards for billing that other insurance companies then adopt.  We should NEVER ask, "what can we charge for," but should always ask, "what work did we do that it is fair for a patient to pay for."  Ignore what medicare and insurance companies say, bill clients for the work we perform and for the results they get.  How much more raw cost is there in staining two Mohs blocks with the same immuno?  Is it fair to charge a patient double the amount for MUCH less than twice the work?

Will Chappell HTL(ASCP), QIHC

On Jun 19, 2012, at 9:15 PM, Kim Donadio wrote:

> Great team work! Job well done and a absolute answer is given. 
>  
> Thank you 
> 
> 
> ________________________________
> 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: Tuesday, June 19, 2012 2:10 PM
> Subject: RE: [Histonet] Billing IHC on MOHS
> 
> 
> The following is the response I recived from a coding specialist at the American Academy of Dermatology.  I am trying not to be concerned that the reference is 6 years old but I think it clears up what we thought to be true.  
> 88342 for IHC
> 88314 other “special stains”
> Here is the description for 88314 according to November 2006 cpt Assistant article, the companion piece to the AMA CPT Code Book.
> The work of processing and interpreting one routine stain is included in the procedure 17311- 17315. This stain is usually hematoxylin and eosin, or toluidine blue. If other special stains are necessary after one routine stain, then the code for special stains may be used (88314) as well as immunoperoxidase stains (88342) or decalcification procedures (88311). Special stains are not typically used and in most Mohs practices are of low frequency. Each stain is reported only once per block, not per slide or per layer (stage).
> AMA CPT definition of a Block:Tissue flattened by cutting into pieces, embedded, and frozen in mounting medium used by histotechnologists to embed tissue for frozen sections.
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