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Posted By Danielle Levy on 01-09-2019, 10:44:06 in Ob-Gyn
We have a physician in our practice who is a vulvology specialist who uses the microscope to perform most of his services . Is there any codes he can use other then E/M services . All the microscopic codes look as if we needs to be a radiologist to use them . Also not we do have a special CLIA license . Any suggestions would be most appreciated . Thanks
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Posted By Melanie Witt on 01-09-2019, 12:02:11
You need to describe what he is doing. Despite his using a microscope to look at sample from the vulva, which is what I am assuming he is doing, he is not a pathologist and only the pathology codes are available for billing purposes for doing so - the only code available in this section of CPT is for diagnostic use of an electron microscope (88348). There were also some new codes added to CPT in 2017 for something called Reflectance Confocal Microscopy of the skin (96931-96936) but this requires use of specialized equipment that produces mosaic images. According to the CPT Assistant Article on this topic "The RCM imaging device provides noninvasive high-resolution imaging of the epidermis and superficial dermis of human skin, and is used in the pathological examination of suspicious skin lesions. The technology may allow for early detection and diagnosis of skin cancers, benign skin lesions, and other skin disorders. RCM can scan 8 mm x 8
mm areas of skin at successively deeper levels, which means that a larger diagnostic image of a skin lesion (typically the entire lesion) is produced. This process may make it easier for the physician to determine if a lesion is benign, malignant, or premalignant. It can facilitate further diagnostic and treatment decision making, including the need for a tissue biopsy, excision, or destruction."

So the short answer is that unless he is actually performing this new procedure, there may be no mechanism currently to get him paid for using the microscope. There may also be a coverage issue with RCM as the codes were intended to be reported by dermatologists, but also because Medicare has determined that the procedure is not medically necessary due to insufficient evidence for this emerging technology.
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