Otolaryngology Coding Alert

Now that you know that your otolaryngologist meets CPT's criteria for Mohs surgery, make sure you understand how to use the CPT codes.

For the first lesion layer that the surgeon removes, assign 17304 (Chemosurgery [Mohs micrographic  technique], including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and complete histo-pathologic preparation including the first routine stain [e.g., hematoxylin and eosin, toluidine blue]; first stage, fresh tissue technique, up to 5 specimens), says Pamela J. Biffle, CPC, CCS-P, an independent consultant in the Dallas/Fort Worth area and a professional medical coding curriculum American Academy of Professional Coders-approved instructor. For the second and third layers, use 17305 ( second stage, fixed or fresh tissue, up to 5 specimens) and 17306 ( third stage, fixed or fresh tissue, up to 5 specimens), respectively. For each subsequent layer, report 17307 ( additional stage[s], up to 5 specimens, each stage).

For instance, a dermatologist performs a Mohs micrographic procedure in two stages, dividing each layer into four specimens. You should report 17304 for the first stage and 17305 for the second.

Remember that the definitions for 17304-17307 refer to the first five specimens from each layer that the surgeon collects and examines. During a Mohs procedure, the physician often removes the lesion layers in segments both to make removal easier and to provide specimens that fit on a microscope slide. For every specimen after the fifth, use add-on code +17310 ( each additional specimen, after the first 5 specimens, fixed or fresh tissue, any stage [list separately in addition to code for primary procedure]). Make sure to indicate in units how many specimens beyond the first five that the surgeon removes. Some payers instead may require you to list 17310 appended with modifier -59 (Distinct procedural service).

 Code 17310 is revised in CPT 2003, and it has been a big help, says Carrie Gaul, CPC, office manager for Gaul Dermatology in Spencer, Iowa. In the past, CPT was unclear as to how coders should handle extra specimens from each stage, she says.