Pathology/Lab Coding Alert

Codes 17311-+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] ...) include the histopathology prep and evaluation.

CPT® guidelines with these codes state that Mohs "requires a single physician to act in two integrated but separate and distinct capacities: surgeon and pathologist. If either of these responsibilities is delegated to another physician who reports the services separately, these codes should not be reported."

Additionally, CPT® Assistant (November 2006) includes this: "'modified' Mohs: A procedure in which the surgeon submits tissue to a pathologist who prepares slides for examination in a manner similar to the Mohs surgeon. Do not report codes17311- 17315 for this staged excision procedure. The surgeon uses appropriate excision and repair codes, and the pathologist reports pathology codes, as appropriate."

In other words, the only way for you to bill for the work is if the surgeon uses an excision code (such as 11600-11646, Excision, malignant lesion including margins ...) instead of the Mohs codes, and you report modifier TC (Technical component) with the appropriate pathology code (88305, Level IV - Surgical pathology, gross and microscopic examination, Skin, other than cyst/tag/debridement/plastic repair).