The specific scenario is a MCR pt with a tumor that does not meet the criteria for Mohs. In this instance, we bill excision with frozen sections (the path code 88331 and the size appropriate malignant exc code). It becomes confusing when the lesion is positive and more than one layer is taken. In this case, what we have previously been told that the correct way to bill this is 88331/88332 for each layer and 1 malignant excision code that represents the largest final widest size that was required for complete removal.Appreciate your assistance.
The July 2000 AMA CPT Assistant on page 4 provided the following coding update that will be helpful to answer your query below:
Pathology Consultation: Coding Frozen Sections
During the course of a surgical procedure, a pathology consultation may be required. Pathology consultations during surgery that involve frozen sections are reported with codes 88331 and 88332.
88331Pathology consultation during surgery; with frozen section(s), single specimen
88332each additional tissue block with frozen section(s)
Frozen sections are often used for intraoperative, rapid preliminary microscopic diagnoses to guide the operating physician to the most appropriate surgical intervention(s).
In code 88331, the phrase "...with frozen section(s), single specimen," has caused some confusion over the intent of the code, prompting some to believe that 88331 can only be used once per surgery, rather than once per specimen. When in fact, multiple, separately submitted specimens may be received during surgery for frozen section examination for diagnosis or immediate evaluation, resulting in the use of multiple units of 88331.
Defining the Terms
In order to properly use these codes, the terms "block" and "section" must be defined. A block is a portion of tissue from a specimen that is frozen or encased in a support medium such as paraffin or plastic, from which sections are prepared. A section is a thin slice of tissue from a block prepared for examination. The examination is usually by light microscopy.
When a section from the first block of tissue from a specimen is examined, code 88331 would be used. When sections from subsequent blocks of the same specimen are examined, the appropriate coding is one unit of service of 88332 for each section examined. An additional unit of service for each block, subsequent to the first, is coded using 88332. If more than one specimen is submitted for consultation, the services for each specimen would be coded as explained above.
Any routine stains (eg, rapid H&E, Wright) applied to the frozen section are included in codes 88331 and 88332. If other techniques (eg, fine needle aspiration, touch preparation, examination of a cell sample) are used in the course of a pathology consultation during surgery, they should be reported using appropriate cytology codes. When the definitive permanent section examination is performed, subsequent to the frozen section during surgery, the appropriate surgical pathology code should be reported.
Example #2: Two separately identified basal cell carcinomas are submitted for diagnosis and evaluation of adequacy of the surgical margins. The first basal cell carcinoma specimen requires one frozen section from one block to confirm the adequacy of excision. The frozen section on the first specimen is coded using one unit of 88331. The second basal cell carcinoma specimen requires two frozen sections on two blocks to assure adequate excision. The first frozen section on the second specimen is coded using one unit of 88331; the second frozen section on this specimen is coded as 88332. Each of the two separately identified basal cell carcinomas is coded as 88305 for definitive examination.