# Mohs - plastics dermatologist



## jlawler (Aug 15, 2012)

Having a hard time getting repairs from MOHS paid.  Our MOHS dr performs the excision and then sends the pt to our plastics dermatologist in a different office location to do the closure.  Would we use the 78 modifier?  Any help getting the closure paid would be greatly appreciated.  We already tried 51 and claim still denied.  Thanks


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## kchappell73 (Aug 20, 2012)

*no post op mods*

Right off the top of my head, my answer is that you wouldnt use any modifiers- especially any that are post op mods. If all you have billed for your Mohs claim is the 17311/17314 codes, they have no global days, so you shouldnt need any mods to get out of a postop period. I'd have to dig in further to make any other recommendations but wanted to throw that out there to start with. Having a different doc perform the repair is not something I have been challenged with. Good luck!


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## drampas3418 (Aug 20, 2012)

We also sometimes send our patients to a plastics guy for closures on mohs...i do not do the billing for the plastics guy but there are times when a pt comes back on a different day to do the closure and i bill those with a modifier 58. i would assume you should use the same as the ins is questioning a closure with no excision so if you should this is a staged procedure (knowing the pt needs to come back to have the closure done) that should tie it in with the incision done at a different time?


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## mitchellde (Aug 20, 2012)

In addition a dx code showing delayed closure will probably help.  You cannot use the cancer dx for the closure since once the excision is complete the cancer is considered to be history.


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