Wiki Frozen Sections w/Mohs

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Sarahp941

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I have a new Mohs surgeon that just started with us and boy does he like frozen sections. Our previous Mohs MD rarely did frozen sections - mainly on a previously treated site that looked suspicious (we didn't charge), but this new MD is on a roll. Out of 15 cases a day, 3-4 of them may have frozen sections. He says they are new suspicious sites he sees during Mohs surgery. So he does a biopsy, performs frozen sections and then decides treatment - always Mohs and always the same day (shocker lol). I have never had frozen sections pay, but he insists that "he does this all the time with no issues from payers". Just wondering if anyone has any insight on coding guidelines. As always, thank you for any advice!


Plan: Mohs Surgery with Pre-op Frozen Section Biopsy
Biopsy and Frozen Section
Accession Number: dbxfz20-0002.

Prior to proceeding with Mohs Surgery, a sample of the lesion was biopsied and submitted for frozen section histologic evaluation. The skin was
cleansed with alcohol and then anesthetized in the usual fashion. A sample of the lesion was then obtained with a 15-blade scalpel and submitted
for analysis. This biopsy was deemed necessary because of the development of a new lesion immediately adjacent to a previous biopsy site. This is
a new lesion and there is a need for the convenience of a biopsy and the treatment on the same day. The specimen was submitted for frozen
section as 1 block. The tissue specimen was frozen in the cryostat, sectioned and stained.

Frozen Section Diagnosis: BCC, SUP & NOD-right mid preauricular cheek
 
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The purpose of a Moh's procedure is successive biopsies until the specimen is totally clear of abnormal cells. And the only way to do that is repeated examinations of the tissue. The coding is done per block and it's in the description of the procedure. The reason it's a Moh's is that it is all completed in one session, one day.
 
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Oh yes, I completely understand Mohs and Mohs guidelines. My issue is when our Mohs surgeon performs a biopsy w/frozen sections separately and then it results into a Mohs. So basically, he wants to bill a 11102, 88331, 17311 and whatever closure. Our Mohs surgeon is saying that he has always been paid for separate frozen sections - which was performed prior to the actual Mohs surgery - but on the same day as the Mohs. Sorry for the confusing question.
 
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This question is directly addressed in the CPT book at the beginning of the Mohs code section:

If a biopsy of a suspected skin cancer is performed on the same day as Mohs surgery because there was no prior pathology confirmation of a diagnosis, then report a diagnostic skin biopsy (11102, 11104, 11106) and frozen section pathology (88331) with modifier 59 to distinguish from the subsequent definitive surgical procedure of Mohs surgery.
 
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Sarahp941 said:
Oh yes, I completely understand Mohs and Mohs guidelines. My issue is when our Mohs surgeon performs a biopsy w/frozen sections separately and then it results into a Mohs. So basically, he wants to bill a 11102, 88331, 17311 and whatever closure. Our Mohs surgeon is saying that he has always been paid for separate frozen sections - which was performed prior to the actual Mohs surgery - but on the same day as the Mohs. Sorry for the confusing question.
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Oh, ok now I get your question. Thanks
 
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