Practice Management Alert

Tip: Don't bill path exam with revised Mohs codes  Physicians, most commonly dermatologists, use  Mohs micrographic surgery to remove complex or ill-defined skin cancer with histologic examination of 100 percent of the surgical margins. In this way, the physician can be sure to remove the entire cancer without sacrificing excess tissue at the margins.

CPT revised the Mohs codes in 2007, as follows:

- 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) (Use 17312 with 17311 only.)

- 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)  (Use 17314 with 17313 only.)

- +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) (Use 17315 with 17311-17314.) Mohs Means One Physician Only An important requirement: You should report 17311-17315 only if the physician both excises the tissue and examines the excised tissue to locate remaining suspicious cells, says Brett Coldiron, MD, a dermatologist and clinical assistant professor of dermatology at the University of Cincinnati. Mohs microsurgery -requires a single physician to act in two integrated but separate and distinct capacities: surgeon and pathologist,- according to CPT.
 
-The Mohs technique has always required the provider to act as both the surgeon and the pathologist. This has not changed from the old codes 17304-17310,- says Barbara Beran, RN, CMM, CPC, practice administrator for Heartland Dermatology and Skin Care Center in Hays, Saline and Great Bend, Kan.

Example: A dermatologist removes a skin lesion 0.8 cm in diameter and sends the specimen to a pathologist for a consultation during surgery. The pathologist fresh-freezes the tissue, processing it in two tissue blocks, and [...]