# Moh's global period



## Mayra E. Ramirez (Jan 27, 2010)

E/M and MOH surgery on the same day-Please, share with me your response to the poll. Thanks


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## FTessaBartels (Jan 28, 2010)

*Not answering poll*

Your poll questions are too simplified, so I'm not answering them.

Why was the patient scheduled?  If the reason for the visit is a "suspicious lesion" and during the E/M you decide to perform MOHS and you can do it immediately, then yes you can use the -25 modifier.

If the reason for the visit is to have the MOHS procedure, then no you cannot separately bill the E/M (unless it is significant and separately identifable - see below). EVERY procedure includes payment for the appropriate Evaluation/managment of the patient.  You are ALREADY being paid for the E/M when you are paid for a procedure.

If you perform a significant, separately identifiable E/M on the same date as a procedure, you can code for the E/M with -25 modifier (for a procedure with 10-day global)  or -57 modifier (for procedure with 90 day global when decision to perform procedure made at that E/M visit).

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## hkatie (Feb 5, 2010)

This may be of some additional help in answering this question.

http://www.aad.org/members/publications/_doc/DDC_00_March.pdf

The article goes from page 4 to page 5. 

I hope that helps.

Best,

Katie Hanninen, CPC, CPCD

(BTW, the AAD Coding Consult archives are by the far the best open source for answering derm specific coding questions.  I access them several times a month.)


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## cwcieri@yahoo.com (Feb 5, 2010)

Hi Katie;

Dumb question; how do you know about the RVUs built into MOHS? Where can I find that? Sorry, I am sure I should know that by now. My MOHS surgeon is demanding E/M visits now because he says "Inga told him he should".

Thank you,
Claire Cieri,CPC,CEMC


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## hkatie (Feb 8, 2010)

Claire,

That's not dumb at all.  In fact, what's dumb is that I apparently don't have anything on file to back up what I wrote.  I just spent the last two hours pouring through all my bookmarks and files trying to figure out where in the world I got that idea.  I'm coming up blank.  So I'm pulling back on that statement for now.

As for the "Inga Defense," this is the first time I've run across a doc using it to his or her advantage.   I've employed it myself multiple times to great effect.

Having said all that, though, and using Inga to back me up, she does indicate that coding e/m on the same day as Mohs is okay if it is medically necessary and significant and separately identifiable.  My surgeon (who is an amazingly accurate coder and documenter and got the only perfect score in the practice on our December audit,) codes e/m about 60% of the time he does Mohs.  

He does some e/m on all Mohs encounters, but I think for him it rises to "significant and separate" when he has to do more than a cursory history and exam.  I've noticed he doesn't code for it on patients who have been in for another Mohs procedure recently.  He never codes e/m on patients who are in just for adjacent tissue transfers, grafts, excisions, ed & c's, LN2, etc unless the patient came without a diagnosis or they are a new referral from another practice.  

I'll try to ask him this week what his threshold is for "significant/separately identifiable" but I have a feeling the answer I'll get is "I know it when I do it."  The answer ought to be in the documentation if I can't get a good sense of it from him.  I'll let you know what I find.  I'll also take another crack at finding out where I got that RVU idea from when I have a few more free hours at home.  In the meantime I apologize for what appears to be bad information that I passed along.

Best,

Katie


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## cwcieri@yahoo.com (Feb 8, 2010)

Thanks so much, Katie! Perhaps the fact that MOHS does not have a global period; unlike say a destruction, therefore, there is no set percentage of pre,intra and post services. Such as 17000 has 10, 80 ,10 with 10 global days. 

Our situation is a referral from another doc in our Derm practice to our MOHS surgeon; est. pt with DX of malignancy. However, no decision has yet been made about what type of surgery to do, etc. Probably will be MOHS but has not yet been decided. MOHS surgeon has not met pt but pt is est. with practice. Therefore, Inga said "of course you should get an e/m for that scenario". Major problem is his documentation because he has rarely done a separate E/M. I don't want to lead him but I can see his point when he has not yet met the pt.... 

Thank you very much for any help and suggestions. 

Claire


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