Pathology/Lab Coding Alert

Learn exception to new NCCI edit pairs with 17311 and 17313

Bundling pathology and special stain codes with Mohs micrographic surgery is not new -- only the Mohs codes are new. But you-ll need to know when and how you can override the edit pairs if you don't want to lose payment for appropriate biopsy or stain services.

The National Correct Coding Initiative, version 13.0, took effect Jan. 1. You can access the edits online at www.cms.hhs.gov/physicians/cciedits/default.asp.

Start Using New Mohs Codes

CPT 2007 eliminated 17304-17310 for Mohs micrographic surgery and replaced them with the following new codes that you should be using as of Jan. 1:

- 17311 -- 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 histopathologic preparation including routine stain(s) (e.g., hematoxylin and eosin, toluidine blue), head, neck, hands, feet, genitalia, or any location with surgery directly involving muscle, cartilage, bone, tendon, major nerves, or vessels; first stage, up to 5 tissue blocks

- +17312 -- - each additional stage after the first stage, up to 5 tissue blocks (list separately in addition to code for primary procedure)

- 17313 -- 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 histopathologic preparation including routine stain(s) (e.g., hematoxylin and eosin, toluidine blue), of the trunk, arms, or legs; first stage, up to 5 tissue blocks

- +17314 -- - each additional stage after the first stage, up to 5 tissue blocks (list separately in addition to code for primary procedure)

- +17315 -- 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 histopathologic preparation including routine stain(s) (e.g., hematoxylin and eosin, toluidine blue), each additional block after the first 5 tissue blocks, any stage (list separately in addition to code for primary procedure).

The new codes break the procedure down into two categories: for head, neck, hands, feet and genitalia; or for trunk, arms and legs. Although the old codes counted -specimens,- the new codes count -blocks,- which simply clarifies the unit of service, says Pamela J. Biffle, CPC, CCS-P, ACS-DE, director of operations for CRN Institutein Fort Worth, Texas.

The old Mohs surgery codes divided the add-on codes into second stage, third stage and each additional stage. But the new codes simply include one add-on code for each additional stage after the first, with a stage including up to five tissue blocks.

Note that 17312, 17314 and 17315 are -add-on- codes, meaning that you should use them in addition to the primary code (17311 or 17313) for the service rendered.

Don't Separately Code Pathology

Because the Mohs procedure includes tissue-block preparation and examination, you should not list additional CPT codes for that service, Biffle says.

In fact, a new text note preceding 17311 and following 88309 states, -Do not report 88302-88309 on the same specimen as part of the Mohs surgery.-

That's why NCCI 13.0 bundles 17311 and 17313 with surgical pathology codes 88302-88309 (Surgical pathology, gross and microscopic examination) and 88300 (Surgical pathology, gross examination only). You should not report both Mohs and surgical pathology codes for the same work.

Exception: But what if the pathologist had performed a biopsy earlier in the day, resulting in a cancer diagnosis that indicated the need for the Mohs procedure -- could you report Mohs and surgical pathology codes together?

Yes, if it's medically necessary. The physician must have a histologic diagnosis from a skin biopsy before beginning Mohs.

If a diagnosis isn't available, she must perform a biopsy to definitively diagnose the skin cancer. CPT Assistant (July 2004) says that the physician may need a new biopsy before performing Mohs if:

- a biopsy report is not available with reasonable effort

- a biopsy has been done more than 90 days before surgery

- the original biopsy is ambiguous.

Same day? Use 59: If the Mohs surgery proceeds on the same day based on the biopsy diagnosis, append modifier 59 (Distinct procedural service) to the pathology code (such as 88305, Level IV -- surgical pathology, gross and microscopic examination, skin, other than cyst/tag/debridement/plastic repair). Modifier 59 indicates that the biopsy is not a component of the Mohs surgery, but is a separate and distinctservice.

Include Stains Unless They Are Truly -Special-

As part of the histopathologic preparation, Mohs procedures include -routine stain(s) (e.g., hematoxylin and eosin, toluidine blue),- according to the code definition. That means for routine stains involved with Mohs, you shouldn't unbundle the service and additionally report special stain codes such as: 

- +88312 -- Special stains (list separately in addition to code for primary service); Group I for microorganisms (e.g., Gridley, acid fast, methenamine silver), each

- +88313 -- - Group II, all other (e.g., iron, trichrome), except immunocytochemistry and immunoperoxidase stains, each

- +88314 -- - histochemical staining with frozen section(s)

- 88342 -- Immunohistochemistry (including tissue immunoperoxidase), each antibody.

NCCI 13.0 enforces this coding principle by bundling each of these stain codes with 17311 and 17312.

Don't miss: If the physician performs an additional stain that is not a typical part of Mohs tissue processing, you can use the appropriate special stain code in addition to the Mohs code(s). -For example, the physician might examine an Oil Red O lipid stain on frozen sections, which would warrant reporting 88314 in addition to the Mohs codes,- says R. M. Stainton Jr., MD, president of Doctors- Anatomic Pathology Services in Jonesboro, Ark.

As the new text note preceding 17311 and following 88314 states, -When a nonroutine histochemical stain on frozen tissue is utilized, report 88314 with modifier 59.-

Using modifier 59 ensures that your payer knows the physician performed a true -special stain- and did not unbundle a routine stain such as H&E.

Another exception: If the pathologist performs a separate biopsy on the same day as Mohs, you just learned that you can override the Mohs/surgical pathology edit pair with modifier 59. But if the pathologist uses a special stain on the biopsy, you could also run into trouble because of the Mohs/special stain edit pairs.

Do this: Append modifier 59 to the bundled code, such as 88312, indicating that the biopsy special stain was a distinct service separate from the Mohs microsurgery.