Pathology/Lab Coding Alert

The codes are new, but Mohs still includes frozen section exam

CPT 2007 updated coding for Mohs micrographic surgery, but a core concept remains -- a single physician acts as both surgeon and pathologist for the procedure.

That means you can't report a -consultation- between surgeon and pathologist -- and the most recent version of the National Correct Coding Initiative adds edit pairs to ensure that you don-t.

Mohs Codes Change

CPT 2007 deleted 17304-17310 for Mohs micrographic surgery and replaced them with 17311-17315. The new codes distinguish between anatomic sites and change the unit of service from -specimen- to -block,- as shown in the primary code definitions:

- 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

- 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.

Mohs Procedure Uses Frozen Sections

Although the code definition doesn't specify the method of -histopathologic preparation,- Mohs involves processing the excised tissue by frozen section, according to Pamela J. Biffle, CPC, CCS-P, ACS-DE, director of operations for CRN Institute in Fort Worth, Texas. That's why some coders might think you can separately report frozen section codes 88331 (Pathology consultation during surgery; first tissue block, with frozen section[s], single specimen) and 88332 (- each additional tissue block with frozen section[s]) with Mohs codes.

But because the code definition specifies that the procedure includes the histopathologic preparation and examination, separately reporting the frozen section would amount to unbundling the service. That's why NCCI 13.0 added code pairs for 17311 and 17313 with 88331 and 88332.

One Physician Means No Consultation

Codes 88331 and 88332 do not just describe frozen section preparation and examination -- they also include a consultation between the surgeon and the pathologist. -Because one physician performs the surgery and pathology service in a Mohs procedure, no consultation occurs,- Biffle says.

Exception: Unlike Mohs, a pathologist can bill for both a frozen section consultation (88331, 88332) and a surgical pathology exam, such as a biopsy, for the same patient on the same day. A patient might have a biopsy procedure that involves a frozen section consultation and undergo a Mohs procedure later in the same day.

Opportunity: If the pathologist performs a frozen section consultation during a surgical biopsy procedure, and the same patient undergoes Mohs later the same day, you can bill separately for both procedures. NCCI lists the 17311-17313/88331-88332 edit pairs with a modifier indicator of -1,- meaning that you can use modifier 59 (Distinct procedural service) to indicate that the charges involve separate procedures.