Mohs Surgery

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Can anyone please help me and guide me on the correct way to code this procedure.

A Stage 1 procedure of Mohs was done on a pt for cancer on their cheek. A multi-layered closure and a flap formation was also done. My initial way to code this was 17311 for the stage 1 then 15574 for the flap formation without a pedicule and then 13132 for the multi-layered closure. I would really appreciate some feed back on this. The supervisor asked if I could bill it with either the stage 1 with the multi layer closure or the stage 1 with the flap formation. Which would pay more? Not sure if I can even bill this all? Please help me!!!
 

thomas7331

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The coding for Mohs procedures does not include closure, so you can always bill for the closure in addition to the Mohs. You haven't provided enough detail about this particular closure to be able to give you much additional information though. You've said this is a flap without a pedicle, but CPT code 15574 is the code for a pedicle flap, so I don't think you're looking the right code range. Most flaps involving just skin (e.g. rotation flaps, advancement flaps) are coded in the 14000-14061 range as adjacent tissue repairs. A 'multi-layered' closure would usually translate as 'intermediate' and code in the 12031-12057 range. 13132 is a complex closure with by definition 'includes repair of wounds requiring more than layered closure'. In either case though, the closure bundles to the flap code unless the documentation supports that is was a separate procedure or separate site, for example the repair of the donor site - it shouldn't be unbundled from the work of the flap itself. And as always, choose the code that best represents what is documented, not what is going to give you the highest reimbursement.
 
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