# Moh’s surgery



## slaglechristine (Jan 16, 2009)

I am a coder biller from Ohio. I bill for two dermatology practices. Recently they've added a physician that specializes in Moh's surgery. I have had no experience with billing Moh's and the office has had no experience in keying the charges either. I am not getting anything paid. Medicare, Medicaid, or private carriers. The codes in question are 17311 and 17312. The denial is for “submission/billing” error with Medicare. 

1)	my practice isn't using any modifiers
2)	my practice is keying the 17312 w/units (my theory is that the units they are using is for actual # of tissue blocks)
3)	this is an example of a claim keyed:

14061-1 unit  dx 173.3
17311-1 unit  dx 173.3
14060-1 unit  dx 173.3
17312-5units dx 173.3
17311-1 unit  dx 173.3

My issue is, in what order should they be keyed, and can you even have units on the 17312? I understand the 78/79 modifiers are going to depend on previous visits/global days. I assume 59's are applicable. I just really need all the help anyone can give me, because my practice is not helping me at all. They feel they are doing it correct, but I'm really questioning that. Thanks


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## Susan (Jan 17, 2009)

Christine;

It would be easier to see the actual operative report to help you with this.  You are correct in needing modifers for the closure, but the only way to know if billing is applying the units incorrectly would be to see the note and see how many stages are being done.  

The easiest way to remember is each stage is a "slice" that is then cut up into 5 blocks (if it is cut up into more than 5 blocks then you need to look at 17315).  Remember to not use modifiers on your add on codes and I would see the modifiers more along the line of a -58 for a staged procedure.

Please feel free to contact me if you have any further questions.


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## slaglechristine (Jan 20, 2009)

*reply to Moh's surgery*

We have requested operative report and copy of encounter form from office.
If and when I receive this can I fax the information to you.  My office email is 
cslagle@adena.org if this would help out any.  

Thank you so much for your help on this.  Thank you again!


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## katerock1 (May 8, 2009)

MOHS coding is very specialized.  I took Inga Ellzey's Mohs coding seminar.

Modifiers are very important.


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## mitchellde (May 9, 2009)

Seeing the op note will help tremendously, but remember that units cannot be used for surgical procedures they are for use with codes that come as a quantity distribution such as drugs or timed services, never surgical procedure.  I can elaborate more once I see the report, I used to code Mohs surgerys every day, for about 5 years, hopefully I have not forgotten everything!
Debra Mitchell, MSPH, CPC-H


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## JessicaHeemskerk (May 15, 2009)

Does the office have a valid CLIA certificate to do the MOHS Surgery?  IF the CLIA # is NOT on the claims, they will ALL be denied.  Check and see if it is on block # 23.  That's where it goes.  Hope this helps.


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