MOHS/CLOSURE

thomas7331

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Yes, this can be done. Depending on the providers and specialties, some payers may still apply the multiple procedure reduction to one or the other provider's claim though, and if done frequently, it can potentially trigger a flag for an audit if the payer suspects that it is being done unnecessarily in order to inflate reimbursement.
 

andersont

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What do you mean by "depending on the providers and specialities"? The doctors that are doing this are dermatologists in the same practice. Thanks
 

thomas7331

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What do you mean by "depending on the providers and specialities"? The doctors that are doing this are dermatologists in the same practice. Thanks
Most payers will treat two providers of the same specialty and in the same group as if they were the same provider, in which case the multiple procedure reductions will apply the same way they would as if it was the same provider doing both procedures. That might not be the case if, for example, the provider doing the closure was a general surgeon instead of a dermatologist, or if they were a provider in a different group.
 

andersont

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So, in this case where both dermatologists are in the same practice, with one doing the MOHS and the other the closure...can they both bill for their services?

Thanks
 
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In our Dermatology practice we often bill both. Our certified Mohs Surgeons do the procedure and our Plastic Surgeons do the repair
 

kjbeams

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Mohs surgeons have their own specialty and Taxonomy # 207ND0101X as do Dermatologists 207N00000X and Plastic Surgeons 208200000X...that's how insurance determines if they will pay for multiple procedures performed on the same day in the same group practice.
The Taxonomy # and their NPI on the claim tell the insurance what specialty they are registered and licensed to practice.
So even though 2 physicians are in the same group practice...they are treated differently if they have different specialties and taxonomy numbers.
Your Mohs surgeon should have a different taxonomy from the other physicians in your Dermatology practice...so yes...they can both bill on the same day.
Only Mohs surgeons can bill those specific CPT codes as it requires them to be both the surgeon and pathologist.
 
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