# modifier for Mohs + bx + destruction premalignant



## mjl903 (May 1, 2012)

I'm not sure where to put the modifier (if needed) in this case senario:

17311 x 2 (scalp and ear)
17000
17003
11100 - 59

I know the biopsy needs a modifer -59, what about the other two procedures? 

The destruction and biopsy was done the same time as the Mohs.  I don't know if the destruction and biopsy were planned to be done  on a previous visit or if it was a decision made just prior to the Mohs procedure.  Any suggestions?

I don't usually code for this doctor.  I've requested the notes, but don't have them yet.

Thank you!


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## Susan (May 3, 2012)

mjl903 said:


> I'm not sure where to put the modifier (if needed) in this case senario:
> 
> 17311 x 2 (scalp and ear)
> 17000
> ...




I think waiting for the notes would be ideal in this situation, but with that said as long as your payer doesn't have any other policies you would only need the -59 on the biopsy.  The 17000 would take a -51 and the 17003 being a add on code would not need anything.  But again, please check the notes first and then with your payer before submitting.


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## mjl903 (May 4, 2012)

thank you!  I am waiting for the notes.  I'll let you know what they say!


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## mitchellde (May 4, 2012)

If a separate Mohs were performed for each location you do not report the 17311 with 2 units you report each one separate.  This is from the Medicare guidelines for billing the Mohs procedures:
"For each additional (separate) lesion treated with Mohs surgery on the same day, bill each first stage as a 17311 or 17313 as appropriate, on a separate claim line with a -59 modifier."
If the destruction and the bx are all on separate sites you will a 59 on each one to keep them from bundling with the Mohs.


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