Mohs surgery for Skin Cancer.
When reporting Mohs surgery for treatment of skin cancer, documentation must confirm that a single provider acted as both the surgeon (excising tissue) and pathologist (immediately examining excised tissue to determine clear margins). ?If either of these responsibilities is delegated to another physician or qualified healthcare professional who reports the services separately the ? [Mohs] codes should not be reported,? according to CPT(R) requirements.
The physician removes tissue in stages and begins by excising the lesion. This is the first stage. The specimen is divided into smaller portions, called blocks. The locations of each block within this stage are carefully mapped, and each block is examined for cancer cells.
17311 Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), head neck, hands, feet, genitalia or any location with surgery directly involving muscle, cartilage, bone, tendon, major nerves or vessels; first stage, up to 5 tissue blocks
+17312 Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), head neck, hands, feet, genitalia or any location with surgery directly involving muscle, cartilage, bone, tendon, major nerves or vessels; each additional stage after the first stage, up to 5 tissue blocks (List separately in addition to code for primary procedure)
17313 Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), of the trunk, arms or legs; first stage, up to 5 tissue blocks
+17314 Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), of the trunk, arms or legs; each additional stage after the first stage, up to 5 tissue blocks (List separately in addition to code for primary procedure)
+17315 Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), each additional block after the first 5 tissue blocks, any stage (List separately in addition to code for primary procedure)
When billing for Mohs, many common services are included, but there are exceptions.
Mohs surgery includes ?routine stains,? such as hematoxylin and eosin (H&E) or toluidine blue. If the physician performs an additional, atypical stain, report the appropriate special stain code. CPT(R) instructs, ?When a non-routine histochemical stain on frozen tissue is utilized, report 88314 [Special stain including interpretation and report; histochemical stain on frozen tissue block (List separately in addition to code for primary procedure)] with modifier 59.?
Finally, CPT(R) tells us that if a repair is performed following Mohs, ?use separate repair, flap, or graft codes.?
Histopathologic examination is included in the Mohs procedure. Do not separately report 88302-88309.