Wiki Question: MOHS Surgery Question

[jenmendoza]

Hello everyone!

I have a quick question regarding MOHS. The case is as follows:

Patient came in on day xx to have staged MOHS(I-III) procedure done on him due to BCC dx. Codes 17311 and 17312 was used. However, upon further examination, provider found out that there is still residual tumor remaining.
The next day pt came back to have the staged MOHS (IV) continued. Code 17312 with modifier 58 was used.

Upon submission to the insurance company, the claim was denied for having the wrong CPT code used, that the add-on code cannot be used alone for a visit without a base code.

My question is, so should the code have been 17311 mod 58 instead, despite being just an additional staged procedure continued from the prior MOHS done the day before?

Any help or suggestions are highly appreciated, thank you so much!

 

[thomas7331]

My question is, so should the code have been 17311 mod 58 instead, despite being just an additional staged procedure continued from the prior MOHS done the day before?

Any help or suggestions are highly appreciated, thank you so much!

Yes, you will code 17311 for the first layer on a given day, even if the Mohs procedure is being continued from a previous encounter.
You should not need a modifier 58, though, since the Mohs procedures do not have any global days.

 

[jenmendoza]

Yes, you will code 17311 for the first layer on a given day, even if the Mohs procedure is being continued from a previous encounter.
You should not need a modifier 58, though, since the Mohs procedures do not have any global days.

I see! Thank you so much for this information, it's really helpful. I haven't been aware the Medicare changed their global days again, so I checked their website and found out it indeed changed. Thank you again! ; v ; )
Quick question: Does this rule apply to any other procedure done, regardless the base code shall always be included first in the visit?

 

[thomas7331]

I see! Thank you so much for this information, it's really helpful. I haven't been aware the Medicare changed their global days again, so I checked their website and found out it indeed changed. Thank you again! ; v ; )
Quick question: Does this rule apply to any other procedure done, regardless the base code shall always be included first in the visit?

I believe that pretty much all payers will deny an add-on code if the base code is not billed at that same encounter. The base is valued to include most of the facility/technical costs of the procedures at a given encounter, so there's no way to appropriate value the add-on codes if the base code isn't included.

 

[jenmendoza]

I believe that pretty much all payers will deny an add-on code if the base code is not billed at that same encounter. The base is valued to include most of the facility/technical costs of the procedures at a given encounter, so there's no way to appropriate value the add-on codes if the base code isn't included.

I agree, this does make sense. Thank you so much for your help!