Otolaryngology Coding Alert

Your otolaryngologist may push you to bill 17304-17310 for the extensive work she performs with Mohs reconstructive surgery, but make sure you understand Mohs micrographic surgery fundamentals before you report these codes.

 Although dermatologists normally perform Mohs micrographic surgery (17304-17310), some otolaryngologists want to bill for this high-paying service. Otolaryngologists, however, usually provide postoperative reconstructive surgery, which you should bill with codes for laceration repair (12000-13000 series), adjacent tissue transfer (14000 series), or flaps and grafts (15000 series), rather than Mohs micrographic surgery codes. Mohs Requires Dual Tasks  CPT does not restrict 17304-17310 to dermatologists. But to bill these codes, the Mohs surgeon must be both the surgeon and the pathologist, says Julie Robertson, CPC, an otolaryngology coding and reimbursement specialist for University ENT Specialists in Cincinnati. "You should use the Mohs codes only if the physician performs both components," she says.
 
Part of the confusion over using these codes is a misunderstanding of what Mohs surgery is. In a nutshell, the doctor removes a thin layer of the lesion, freezes it and immediately checks the margins under a microscope to see if they are clear of cancer, says Pamela J. Biffle, CPC, CCS-P, an independent consultant in the Dallas/Fort Worth area and a professional medical coding curriculum American Academy of Professional Coders-approved instructor. If the margins are not clear, the surgeon takes another layer sometimes several times until she removes a layer that shows no cancer cells under the microscope. In this case, because she acts as a single physician in two integrated but separate and distinct capacities surgeon and pathologist CPT specifies that you would report Mohs micrographic surgery. Use 11600-11646 When ENT Performs Surgery Component Only On the other hand, if either of these responsibilities is delegated to anotherphysician who reports her services separately, the use of the Mohs micrographicsurgery CPT codes is inappropriate, according to CPT. "For instance, if the physiciansends the sample to a pathologist to perform the work, the surgeon would bill for lesion excision and reconstruction, and the pathologist would bill the pathology codesseparately," Robertson says.

When an otolaryngologist performs excision only, some coders wonder if they may use 17304-17310 appended with modifier -52 (Reduced services) to indicate that the physician elected to perform less than the full procedure. But correct coding requires coding to the highest specificity possible, rather than approximating a procedure. Because codes exist for reporting the surgeon's part, reporting 17304-17310-52 to indicate that your otolaryngologist provided the surgical component is inappropriate, Biffle says. "Mohs is a package deal: The physician either does the excision and fresh frozen tissue technique or he doesn't."

The high reimbursement for Mohs codes may tempt otolaryngologists who spend a lot of time removing multiple layers to use 17304-17310 [...]