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
CMS Transmittal No, 857, effective date October 3, 2018 Change Request 10901 Local Coverage Determinations (LCDs) Implementation date January 8, 2019. 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.
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. How Many Stages?
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
C80 ICD-10-CM Diagnosis Code C80. Malignant neoplasm without specification of site 2016 2017 2018 2019 Non-Billable/Non-Specific Code. Type 1 Excludes malignant carcinoid tumor of unspecified site (C7A.00) malignant neoplasm of specified multiple sites- code to each site. Malignant neoplasm without specification of site.
817: Encounter for surgical aftercare following surgery on the skin and subcutaneous tissue.
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.
Unspecified malignant neoplasm of skin, unspecified C44. 90 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM C44. 90 became effective on October 1, 2021.
Code C80. 1, Malignant (primary) neoplasm, unspecified, equates to Cancer, unspecified.
Currently, Mohs surgery, fresh-tissue technique, is the official name for this procedure, because the fixed-tissue technique is rarely used. The acronym MOHS, micrographically oriented histographic surgery, has also been proposed, but it has not achieved widespread recognition.
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.
Malignant neoplasms A malignant neoplasm is cancerous. Unlike benign neoplasms, malignant neoplasms grow uncontrollably and can invade other organs.
A malignant neoplasm (NEE-oh-plaz-um) is another term for a cancerous tumor. The term “neoplasm” refers to an abnormal growth of tissue. The term “malignant” means the tumor is cancerous and is likely to spread (metastasize) beyond its point of origin.
(NEE-oh-PLA-zum) An abnormal mass of tissue that forms when cells grow and divide more than they should or do not die when they should. Neoplasms may be benign (not cancer) or malignant (cancer).
A malignant neoplasm (NEE-oh-plaz-um) is a cancerous tumor, an abnormal growth that can grow uncontrolled and spread to other parts of the body.
ICD-10 code Z51. 11 for Encounter for antineoplastic chemotherapy is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .
These are neoplasms which are currently benign but have characteristics that make it possible for the tumor to become malignant. One final category is available for unspecified neoplasm, which is used when pathology has not yet determined the specific behavior of the neoplasm.
If a Mohs procedure is performed on a completely separate lesion on the same date of service, each first stage (CPT code 17311 or 17313) code should be reported on a separate claim line with a -59 modifier signifying a separate and distinct lesion. If additional stages are required on the additional lesion, report the second stage codes (CPT code 17312 or 17314) on separate claim lines with a -59 modifier (Reference AHA Coding Clinc, Volume 13, Number 3).
Modifier -59 should only be appended to the pathology codes, by the Mohs surgeon, if a biopsy is performed on a completely separate lesion that does not involve the Mohs surgery; however, Mohs surgery and pathology service may be reported when tissue separate from the tissue examined during the Mohs surgery is submitted for subsequent formalin-fixed processing and histopathologic examination (i.e., the submitted specimen originates from the same operative site or from a different operative site but is not the same tissue processed during the Mohs surgery). Reference AHA Coding Clinc, 2013, Volume 13, Number 3 and NCCI Chapter 3 for additional information.
All surgical procedures performed in the same operative session should be reported on the same claim.
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
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), OF THE TRUNK, ARMS, OR LEGS; FIRST STAGE, UP TO 5 TISSUE BLOCKS
When reporting Mohs surgery for treatment of skin cancer, documentation must confirm that a single provider acted as both the surgeon and pathologist. From there, you need only know the location of the treated lesion, plus the number of “stages” and required tissue blocks, to select an appropriate code.
11100-59 (for the biopsy) 88331-59 (for the frozen section of the biopsy) Stains. Mohs surgery includes “routine stains,” such as hematoxylin and eosin (H&E) or toluidine blue. If the physician performs an additional, atypical stain, you may report the appropriate special stain code.
The exception to this rule occurs when there is “no prior pathology confirmation of a diagnosis, ” according to CPT®. In such a case, the same-day biopsy (11100 Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; single lesion, +11101 Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; each separate/additional lesion (List separately in addition to code for primary procedure) ), and frozen section pathology (88331 Pathology consultation during surgery; first tissue block, with frozen section (s), single specimen) may be reported separately, in addition to the Mohs surgery. You must append modifier 59 Distinct procedural service to the biopsy and pathology codes to confirm these procedures are not a routine part of the Mohs procedure.
Scenario 2: The patient presents with a squamous cell carcinoma of the nose. After prepping the patient and site, the physician removes the carcinoma (first stage) and divides the stages into six tissue blocks for examination. Upon microscopic examination, the physician finds there are positive margins. He removes the positive margin with another excision (second stage), which is divided into three tissue blocks for examination. Upon microscopic examination, the physician finds the margins are negative.
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.
Scenario 3: The patient presents with three skin cancers: basal cell carcinoma of the right neck, squamous cell carcinoma of the right hand, and squamous cell carcinoma of the left ala. After prepping the patient and the sites, the physician first removes the BCC of the neck. He divides it into two tissue blocks. Under microscopic examination, the margins are negative. Next, the physician removes the SCC of the hand, dividing that stage into three tissue blocks. Under microscopic examination, the margins are negative. Lastly, the physician removes the SCC of the left ala, dividing the stage into six blocks. Under microscopic examination, there is a positive margin. The physician then takes a second stage, which is divided into two blocks. Under microscopic examination the margins are negative.
If the surgeon/pathologist uses the Mohs technique on multiple lesions during the same session, code for each lesion separately.
A primary malignant neoplasm that overlaps two or more contiguous (next to each other) sites should be classified to the subcategory/code .8 ('overlapping lesion'), unless the combination is specifically indexed elsewhere.
The Table of Neoplasms should be used to identify the correct topography code. In a few cases, such as for malignant melanoma and certain neuroendocrine tumors, the morphology (histologic type) is included in the category and codes. Primary malignant neoplasms overlapping site boundaries.
The 2022 edition of ICD-10-CM C76.42 became effective on October 1, 2021.
A primary malignant neoplasm that overlaps two or more contiguous (next to each other) sites should be classified to the subcategory/code .8 ('overlapping lesion'), unless the combination is specifically indexed elsewhere.
Malignant neoplasms often metastasize to distant anatomic sites and may recur after excision. The most common malignant neoplasms are carcinomas (adenocarcinomas or squamous cell carcinomas), hodgkin and non-hodgkin lymphomas, leukemias, melanomas, and sarcomas.
New abnormal tissue that grows by excessive cellular division and proliferation more rapidly than normal and continues to grow after the stimuli that initiated the new growth cease; tumors perform no useful body function and may be benign or malignant; benign neoplasms are a noncancerous growth that does not invade nearby tissue or spread to other parts of the body; malignant neoplasms or cancer show a greater degree of anaplasia and have the properties of invasion and metastasis; neoplasm terms herein do not distinguish between benign or malignant states, use references listed to cover this concept.
The Table of Neoplasms should be used to identify the correct topography code. In a few cases, such as for malignant melanoma and certain neuroendocrine tumors, the morphology (histologic type) is included in the category and codes. Primary malignant neoplasms overlapping site boundaries.
There are several main types of malignancy. Carcinoma is a malignancy that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a malignancy that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a malignancy that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are malignancies that begin in the cells of the immune system. Central nervous system cancers are malignancies that begin in the tissues of the brain and spinal cord.
Sarcoma is a malignancy that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a malignancy that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood.
The 2022 edition of ICD-10-CM C80.1 became effective on October 1, 2021.
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.