Quick Coding for Mohs

Quick Coding for Mohs

by John Verhovshek, MA, CPC

When reporting Mohs surgery for treatment of skin cancer, documentation must confirm that a single provider acted as both the surgeon (excising tissue) and pathologist (immediately examining excised tissue to determine clear margins). Per CPT®, “if either of these responsibilities is delegated to another physician or qualified health care professional who reports the services separately, the… [Mohs] codes should not be reported.”

CPT® categorizes Mohs procedures by location:

For lesions of the head, neck, hands, feet, and genitalia—or, any location with surgery directly involving muscle, cartilage, bone, tendon, major nerves, or vessels—look to 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) (eg, 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 and add-on code 17312 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) (eg, 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; each additional stage after the first stage, up to 5 tissue blocks (list separately in addition to code for primary procedure). Report 17312 only with 17311.

For lesions of the trunk, arms, and legs, select 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) (eg, hematoxylin and eosin, toluidine blue), of the trunk, arms or legs; first stage, up to 5 tissue blocks and add-on 17314 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) (eg, hematoxylin and eosin, toluidine blue), of the trunk, arms or legs; each additional stage after the first stage, up to 5 tissue blocks (list separately in addition to code for primary procedure). Report 17314 only with 17313.

Note that 17311-17314 define “up to five tissue blocks.” If a single stage must be divided into more than five blocks, you may report an add-on code for each additional block, beyond the initial five, using +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) (eg, 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). You may report 17315 with all codes 17311-17314, when appropriate.

To spare as much healthy tissue as possible, the physician removes tissue in “stages.” She begins by excising the lesion. This is the first stage. The specimen is divided into smaller portions, called “blocks.” The location of each block within the stage is carefully mapped, and each block is examined for cancer cells.

Where the surgeon sees a clear margin (no malignant tissue), no further excision is necessary beyond that block. Where the physician finds malignancy, a further stage is required to remove additional material (this is the second stage, which is again divided into blocks). The process continues, until no further cancer cells are identified.

In other words, each time the surgeon excises tissue counts as a stage. Each slide resulting from an individual stage counts as a block.

For example, a patient presents with a squamous cell carcinoma of the nose. After prepping the patient and site, the physician removes the carcinoma (first stage) and divides the stages into six tissue blocks for examination. Upon microscopic examination, the physician finds there are positive margins. He removes the positive margin with another excision (second stage), which is divided into three tissue blocks for examination. Upon microscopic examination, the physician finds the margins are negative.

This scenario would permit 17311 for the first stage and +17312 for the second stage. Additionally, because the first stage was divided into six tissue blocks, you may also report +17315.

Note that if the surgeon/pathologist uses the Mohs technique on multiple lesions during the same session, you should code for each lesion, separately.

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John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

About Has 404 Posts

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

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