# MOHS question re:SCC insitu dx



## Texascoder64 (Feb 27, 2014)

I am not seeing anywhere that the 232.x  SCC insitu is allowed for MOHS; is this correct?  
The physician wants to use the SCC 173.x2 code for the MOHS surgery, but the path report clearly states insitu; any input would be helpful.

thank you


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## drampas3418 (Feb 27, 2014)

in situ is a good diagnosis for mohs surgery. not sure where you are looking up your info but on our nj medicare website under the mohs medical policy the 232 codes are good codes


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## Texascoder64 (Feb 27, 2014)

I pulled up the LCD on Novitas that is our MAC in TX and it does not list the 232.x codes ?  Am I overlooking something

Thank you so much


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## drampas3418 (Mar 4, 2014)

novitas is ours also. the 232 codes are listed , not sure why you are not showing them on your lcd. sorry


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## Texascoder64 (Mar 6, 2014)

When I pull up Novitas Texas for part B Mohs LCD list of ICD9 does not have 232.x on the list.
Although it does list Bowens disease( SCC insitu) as indication for MOHS

Does not make sense why they would not list 232.x  on the covered dx listing.
I billed one and it denied with this code.


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## mitchellde (Mar 6, 2014)

that is a shame but a CA insitu should not need a MOHS if on initial excision this is what the path showed. once a CA insitu is removed then there is no cancer left behind, so there is no medical necessity for a MOHS.  It migh be helpful to know the entire scenario, such as is this the initial excision? if so what did the provider document as the reason for setting up the MOHS?  or was the initial excision a SCC and that was the reason for the MOHS?  when was the CA insitu diagnosis rendered?  If this was dueing the MOHS then your provider rendered the diagnosis since he must act as his own pathologist.  If the speciment was sent out then you cannot bill a MOHS anyway.


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## Texascoder64 (Mar 8, 2014)

Very interesting and helpful response Debra.  I will go back through all notes and path(s) and research further.  This gives me insight of what to look for From what I remember ( I do not have the notes at the moment) the initial procedure was a shave by another Dr in the group (who also is a dermatopathologist, read the path as SCC insitu) and referred to the MOHS surgeon in the group.  Would you still question if payer will deem the mohs as medically necessary for this diagnosis ?

thank you!


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## mitchellde (Mar 8, 2014)

yes I would.  CA in situ is a cancer that has no invasive component.  I was always instructed by our doctors that excision of the CA in situ is definitive treatment and after this it is hx of cancer.  So if it is excised and is defined as CA situ then where is the medical necessity for the MOHS.  Or is it SCC that has been caught early and MOHS is appropriate treatment to remove all invasive components.    I would never question a providers diagnosis or even the treatment he has decided upon, however your provider must understand the payer will only pay those services deemed medically necessary.  You as a coder must code what has been documented. So the payer says, if the dx is CA insitu there is no medical necessity for the MOHS, then you must respect this..  If this has already been documented as such then there is little that you can do.


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## Texascoder64 (Mar 10, 2014)

Thank you Debra!


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