Billing/Coding question for Frozen sections

[musom]

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Scenario:

Part 1, Lumpectomy: frozen on margins
Part 2, additional margin: frozen on new margin
Part 3, Sentinel node #1: frozen
Part 4, Sentinel node #2: frozen

Billing, which is it?

#1: 88331 x 4

OR

#2: 88331 x 1, 88332 x 3

 

[Gene_]

#1.

Each specimen gets its own 88331. Any additional frozen sections on that specimen are 88332.

 

[Autopsy101]

#1

 

[icpshootyz]

Agree with above. Any frozen done on an individual specimen is 88331. The only time you use 88332 is for a second frozen section (or more) on the same specimen/part.

 

[pathstudent]

And don't forget that if it is a gross assessment only intraoperative consult or they need to come show you something in OR, document it and bill 88329.

If you do touch prep with a frozen (as many sentinel nodes and brain tumors do) don't forget to bill and 88334 in addition to the 88331 (you can't bill and 88333 with an 88331).

 

[Tiki]

People still freeze breast margins and sentinel nodes?

 

[Torsed]

I know many newer surgeons don't freeze SLN, but we got some older ones that do. I always try not to freeze breast tissue.

 

[Ishie1013]

A lot of our surgeons freeze SNs but then we do the three slide protocol on the remainder. I'll TP them if they look like they're going to be fatty.

*Hate* freezing breast margins. Got occasional retroareolar fat (also kind of a nightmare to freeze) but the actual margin was a rare thing, but always a rampaging pain when it happened.

We didn't really freeze melanoma SNs, thank god.

 

[Gene_]

If you do touch prep with a frozen (as many sentinel nodes and brain tumors do) don't forget to bill and 88334 in addition to the 88331 (you can't bill and 88333 with an 88331).

I don't know about billing the 88334 anymore. My interpretation of the most recent Padget coding manual was to not code 88333 or 88334 with an 88331. I could very well be wrong about this.

 

[ygdrasil]

I don't know about billing the 88334 anymore. My interpretation of the most recent Padget coding manual was to not code 88333 or 88334 with an 88331. I could very well be wrong about this.

We still bill 88331 + 88334 on rare cases, such as brain lesions when we do a squash prep, still don't know what to call it, then try a frozen. Medicare may or may not pay it, but BC/BS et al. still seem to.

 

[Tiki]

Wow, I'm suprised so many institutions still freeze sentinel nodes. Glad my institution doesn't freeze these.

 

[yaah]

We get frozens on sentinel nodes when there is a mastectomy with immediate reconstruction. They don't want to go back into the axilla after a reconstruction, and they don't want to delay the reconstruction if they don't have to. Unfortunately it seems like most of the breast cases we get are mastectomies with reconstruction. And a lot of these are offsite frozens where we have to send someone to a smaller hospital just for that purpose. Not very efficient. It has been a hard battle to reduce or eliminate these. And our institution is not one that I would say does excessive frozens.

We never freeze margins though.