# Mohs Consult Days Before Mohs Surgery



## MedicalCoderBiller (Aug 19, 2014)

I have a Mohs surgeon that wants to bill out a MOHs consult as an office visit and then days later do the MOHs surgery and bill it out. My question is, can I bill out the MOHs consult as an office visit or should those be included in the MOHs surgery bill? The surgeon wants to bill out the consult as an office visit because he has never met the patient before.


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## bethb (Aug 19, 2014)

He should be able to bill out a consult (if the criteria for a consult was met) for his consultation service (E/M criteria).  Mohs procedures do not have a global period, however, many of the closures performed do have global days.  Our dermatologist sees the patient, and performs a biopsy usually at the initial visit.  If the pathology comes back as squamous or basal cell carcinoma and Mohs is the procedure he plans to do, then a separate Mohs surgery is scheduled for the patient.  I hope this helps.


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## MedicalCoderBiller (Aug 19, 2014)

Thank you!!! Should I bill the consult visit codes or the office visit codes (ex: 99214)?


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## CatchTheWind (Aug 21, 2014)

Bill the office visit codes.  This is for two reasons:  (1) Most payers (including Medicare) no longer accept consult codes, and (2) Consult codes can only be used when you see the patient in order to advise the treating doctor; if you are going to be treat the patient, it is not a coded as a consult.

Global surgery rules state that the 10 day-global period includes the day of surgery plus ten days after it.  The 90 day global period includes the day before surgery, the day of surgery, and 90 days after. Since flaps and grafts are the only common derm procedures with 90 days, this office visit is billable unless a flap or graft repair is done the next day.  (If you don't know in advance what kind of repair is going to be done, you may want to hold the office visit claim until you know.)


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## CatchTheWind (Aug 21, 2014)

I think I made a mistake, and I want to correct it.  According to the CPT book, although billing a consult does require documentation that it was requested by another provider, and a report must be provided to the referring provider, it does not prevent you from providing subsequent care. 

Therefore, if you are billing a carrier that pays for consult codes, and if you've met the above conditions, you could bill it as a consult.


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## MedicalCoderBiller (Aug 21, 2014)

I should have added:

Example: The patient sees a provider in our practice and has an office visit. Then they are scheduled to see the mohs surgeon and there is another office visit for the mohs consult. Then the patient is scheduled for mohs surgery. 

Is the consult/office visit allowed to be billed out when the patient already saw a provider in the same practice? The diagnosis used for the mohs consult office visit is the diagnosis used for the mohs surgery as well.


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