Wiki Billing CPT 15783 after Mohs Surgery - PLEASE HELP

[clingnofski]

When billing CPT code 15783 (Dermabrasion), after a MOHS Surgery, to show that it is a medically necessary procedure, is the primary code used for the MOHS Surgery allowed to be used as the primary code for the Dermabrasion? Also, should a modifier 58 be applied? What is the best way to show (and get paid for) CPT 15783 is medically necessary and should not be denied as cosmetic? Please advise... THANKS!

 

[danskangel313]

When billing CPT code 15783 (Dermabrasion), after a MOHS Surgery, to show that it is a medically necessary procedure, is the primary code used for the MOHS Surgery allowed to be used as the primary code for the Dermabrasion? Also, should a modifier 58 be applied? What is the best way to show (and get paid for) CPT 15783 is medically necessary and should not be denied as cosmetic? Please advise... THANKS!

The documentation would need to explain/discuss the reason(s) why dermabrasion would be the best option for wound healing, without consideration of how a scar may look.

We have patients come through our Burn Unit all the time who require "cosmetic" procedures after their skin grafts heal, but these treatments are for situations like a graft healing and pulling the skin too tight so a patient's limbs don't bend or they can't sit or lay down properly. Treating eyelids is one of the most frequent "cosmetic" repairs that are done. If a patient is unable to shut their eyes after a facial skin graft, treatment for that is clearly medically necessary (yes, this happens more than you think).

In your situation, is the provider performing any type of repair immediately following the procedure to close the defect or is this a second intention wound healing situation? At what point is the dermabrasion treatment coming into play? What's the purpose or reason for the dermabrasion?

 

[clingnofski]

Yes, immediate repair is done after the procedure. The dermabrasion is coming into play usually about 6-8 weeks after the MOHS procedure if there is still bleeding occurring and suture granuloma is notated. It is not done on all MOHS patients, only ones where the wound is not properly healing, which we know can sometimes occur. My argument is that this isn't necessarily cosmetic, because it is due to the MOHS surgery that the patient is having to have this performed and since we sometimes know this to be the case a modifier 58 would help us show it is non-cosmetic. What my doctor worries about is using the original malignant code again as the primary code since technically the cancer is gone but, I have been told Z codes should not be used as primary, perhaps we should try L92.3 (Foreign body granuloma) - but that doesn't tie it to the original MOHS surgery which I think we should have a code in there that does.

 

[danskangel313]

Yes, immediate repair is done after the procedure. The dermabrasion is coming into play usually about 6-8 weeks after the MOHS procedure if there is still bleeding occurring and suture granuloma is notated. It is not done on all MOHS patients, only ones where the wound is not properly healing, which we know can sometimes occur. My argument is that this isn't necessarily cosmetic, because it is due to the MOHS surgery that the patient is having to have this performed and since we sometimes know this to be the case a modifier 58 would help us show it is non-cosmetic. What my doctor worries about is using the original malignant code again as the primary code since technically the cancer is gone but, I have been told Z codes should not be used as primary, perhaps we should try L92.3 (Foreign body granuloma) - but that doesn't tie it to the original MOHS surgery which I think we should have a code in there that does.

I would agree using a primary code specific to the problem is best. You're still going to have to include the neoplasm code because it's relevant to the situation - the MOHS defect is due to the removal of the tissue. And, although the tissue has been removed, it doesn't necessarily mean the patient is now free of that malignancy.

I don't know about L92.3 for your situation regarding the sutures. If there's infection, you could code specific to that. You could also try looking at T81.3- or T81.4- as well.

For the modifier, because of the nature of the problem, is the patient returning to the OR for the dermabrasion treatment? If so, then you might want to look into a 78. If not, then a 58 would probably be your only option.