For lesions of the trunk, arms, and legs, select code 17313 and add-on code 17314. Regardless of location, you might also need to report add-on code 17315, as explained in the Mohs Code Definitions sidebar. Step 3:
Full Answer
CPT ® categorizes Mohs micrographic surgery procedures by location, with one code set for head, neck, hands, feet, and genitalia, and a second code set for trunk, arms, and legs. Both anatomic categories include an add-on code for each additional stage after the first, with a stage defined as including up to five tissue blocks:
[Mohs] codes should not be reported.” For lesions of the head, neck, hands, feet, and genitalia, or any location with surgery directly involving muscle, cartilage, bone, tendon, major nerves, or vessels, look to code 17311 and add-on code 17312. For lesions of the trunk, arms, and legs, select code 17313 and add-on code 17314.
“The Mohs surgeon removes the tumor tissue and maps and divides the tumor specimen into pieces, and each piece is embedded into an individual tissue block for histopathologic examination. Thus a tissue block in Mohs surgery is defined as an individual tissue piece embedded in a mounting medium for sectioning.” (CPT 2021, Professional Ed. page. 119)
Modifier 59 is used on the biopsy code, because Mohs surgery has higher RVUs, and it is reported without a modifier. Don’t have a login? Learn more about membership
The appropriate MOHS surgery code should be reported with the appropriate quantities for the specimens mapped in the days/units field. CPT code 17312 should be reported for additional stages with the first stage code 17311. CPT code 17314 should be reported for additional stages with the first stage code 17313.
817: Encounter for surgical aftercare following surgery on the skin and subcutaneous tissue.
CPT® 17311, Under Mohs Micrographic Surgery Procedures The Current Procedural Terminology (CPT®) code 17311 as maintained by American Medical Association, is a medical procedural code under the range - Mohs Micrographic Surgery Procedures.
Mohs surgery is performed to remove complex or ill-defined skin cancer, and the procedure includes both the surgery and histopathologic examination. Both capacities are required in order to bill for these codes, and neither part may be delegated to another individual. Repair is not included in the coding.
81 for Encounter for surgical aftercare following surgery on specified body systems is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .
CPT Code 17311 - Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (e.g., hematoxylin and eosin, toluidine blue), ...
Mohs surgery is covered by most insurance plans, including Medicare.
CPT® Code 14060 in section: Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips.
12051-Intermediate repair, face, ears, eyelids, nose, lips, mucous membranes, 2.5cm or less.
Mohs surgery is a highly specialized technique in dermatologic surgery for treating skin cancer. The procedure is named for Frederick E. Mohs, the surgeon who developed the technique, and is also known as Mohs micrographic surgery.
Lack of these details, or a statement of “single layer closure,” suggests a simple repair. Complex repairs involve wounds that are deeper and more dramatic, which may require debridement or significant revision: “Complex repair …
The specimen is divided into smaller portions, called blocks. Per CPT®, “a tissue block … is defined as an individual tissue piece embedded in a mounting medium for sectioning.” The location of each block within the stage is carefully mapped, and each block is examined for cancer cells.
By Susan Ward, CPC, CPC-H, CPC-I, CDERC, CEMC, CPRCMohs micrographic surgery is a highly-effective technique for treating skin cancer, which common...
CPT® categorizes Mohs micrographic surgery procedures by location, with one code set for head, neck, hands, feet, and genitalia, and a second code...
To select the correct Mohs micrographic surgery codes, you should know—in addition to location—how many stages of each lesion the physician excised...
An exception to this rule may occur if a pathologist had performed a biopsy with a confirmed cancer diagnosis, which results in a same-day Mohs mic...
Mohs surgery is performed to remove complex or ill-defined skin cancer, and the procedure includes both the surgery and histopathologic examination. Both capacities are required in order to bill for these codes, and neither part may be delegated to another individual.
Repair is not included in the coding. If an intermediate or more complex repair is needed and performed, a repair, flap or graft may be reported separately. The codes for reporting Mohs procedures have zero global days; if the Mohs physician also performs the medically necessary repair, global days may apply to the repair codes.
To select the correct Mohs micrographic surgery codes, you should know—in addition to location—how many stages of each lesion the physician excised, and how many blocks the physician divided each stage into.#N#For example, a patient has a squamous cell carcinoma on the tip of the nose. After prepping the patient and site, the physician removes the carcinoma (first stage) and divides it into eight blocks for examination. Seeing positive margins, he removes a second stage, which he divides into five blocks. The physician again identifies positive margins. He performs a third stage and divides the specimen into three blocks proving to be clear of carcinoma. The appropriate coding in relative value unit (RVU) order is:#N#17311— (first stage)#N#17312 x 2— (second and third stage)#N#17315 x 3— (blocks, six, seven, and eight from the first stage)#N#Diagnosis: 173.3 Malignant carcinoma of skin, other and unspecified parts of face#N#If the physician performs Mohs micrographic surgery on four separate lesion sites, you should apply the Mohs micrographic surgery codes once per lesion. For example, if the physician performs stage one on four leg sites, report four units of 17313; for stage two on the same four sites, report four units of 17314; and so on.#N#In the majority of circumstances, you would not list a pathology exam code in addition to the Mohs micrographic surgery code for the same service. CPT ® guidelines specify, “Do not report 88302-88309 on the same specimen as part of the Mohs surgery.” The National Correct Coding Initiative (CCI) bundles 17311 and 17313 with surgical pathology codes 88302-88309 and 88300 Surgical pathology, gross examination only.
Mohs micrographic surgery is a highly-effective technique for treating skin cancer, which commonly includes basal cell carcinoma and squamous cell carcinoma. Mohs micrographic surgery is used less often for patient with melanoma, which requires permanent pathology rather than frozen sections. The procedure is usually done in an outpatient setting, ...
After prepping the patient and site, the physician removes the carcinoma (first stage) and divides it into eight blocks for examination. Seeing positive margins, he removes a second stage, which he divides into five blocks. The physician again identifies positive margins.
When the physician uses stains such as hematoxylin and eosin (H&E), you cannot claim the surgical pathology special stain codes in addition to the Mohs micrographic surgery codes. The Mohs micrographic surgery definition states the procedure includes routine stains, such as H&E or toluidine blue.
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Italicized font represents CMS national language/wording copied directly from CMS Manuals or CMS Transmittals. Contractors are prohibited from changing national language/wording.
The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the associated LCD L35494 Mohs Micrographic Surgery. The medical records should clearly show that Mohs surgery was chosen because of the complexity, size and/or location of the lesion and why other approaches are not medically necessary and reasonable.
It is the responsibility of the provider to code to the highest level specified in the ICD-10-CM. The correct use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination.
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
17311 – Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain (s) (eg, hematoxylin and eosin, toluidine blue), head, neck, hands, feet, genitalia, or any location with surgery directly involving muscle, cartilage, bone, tendon, major nerves, or vessels; first stage, up to 5 tissue blocks – Average fee payment – $650 – $670
Modifier 59 is also appropriate when a separate skin lesion, other than the lesion for which MMS is performed, is biopsied on the same day that the MMS is performed.
It is NOT appropriate to report the 59 modifier (distinct procedural service) when the biopsy and Mohs’ surgery is performed on the same lesion, in the same operative session, on the same date of service . The -59 modifier should be reported when a biopsy or excision of lesion is performed in situations other than stated above.
Medicare is aware that a biopsy of the skin lesion for which MMS is planned is necessary in order for the physician to determine the exact nature of the lesion (s) to be removed. Occasionally, that biopsy may need to be done on the same day that MMS is planned to be done.
Do not report modifier -59 on the same detail line as the Mohs surgical procedure. A Clinical Laboratory Improvement Act (CLIA) certification number is required on all claims submitted for Mohs surgery billed with any of the following CPT codes, 17311-17315.