Part B Insider (Multispecialty) Coding Alert

Heads up: A little-noticed proposal in the 2008 Medicare fee schedule could slash your reimbursement for Moh's micrographic surgery (17311-17315). Medicare wants to apply the Multiple Procedure Payment Reduction if your doctor performs more than one Moh's procedure in the same session.

Medicare believes the costs will be lower for multiple procedures because some services will overlap. But this reasoning doesn't apply to Moh-s, argued Thomas Stasko, director of Moh's for Vanderbilt University Medical Center in Nashville in written comments.

The July 2004 CPT Assistant explains: -There is very little overlap or reduction in work when two or more tumors are treated on the same patient on the same day. Therefore Moh's surgery codes are exempt from the use of modifier 51.-

In particular, the doctor must perform separate pre-service positioning, pre-service scrub, dress and wait time, and intraservice work for each separate tumor, Stasko insisted. And any reconstructive procedures after the Moh's must also stand on their own.