NAMAS Webinar Q&A: Auditing for MOHS Surgery 09/03/19

Post here your questions regarding auditing ,coding, documentation, and compliance. Also, join in on the conversation- help your fellow auditors and compliance professionals in the industry.

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Mon Sep 09, 2019 10:51 am

Below are the questions received during our recent webinar, Auditing for MOHS Surgery, originally presented on September 3, 2019. These questions have been answered by the webinar presenter, Kelley Chappel Larkins, CPMA, CPC

Question: Are the blocks per stage, or en total?
Answer: You can add up the blocks across stages and bill one line with the total units. For example, see the Mohs map on slide 27. Stage three has 8 blocks, stage four has 7 blocks, and stage five has 6 blocks. We can bill the 17315 for anything above 5 blocks. So stage three gets 3 units, stage four gets 2 units, and stage five gets 1. Bill 17315 for 6 units.

Question: When coding for the reconstruction that is done at a later date, it would be a “history of” code since with Mohs they are removing it all?
This is a debated answer but here are the reasons that form my opinion:
a. Had you done the reconstruction on the same day, you’d have billed the whole surgery with the same diagnosis
b. Using a 58 modifier on the later date reconstruction can help convey that it was “(a) planned or anticipated(staged) and or (c) for therapy following a surgical procedure.” (see CPT definition of modifier 58). One might argue that modifier 58 is a post op modifier and Mohs has no post op days so this can’t apply. I have a carrier that requests we use it anyway. Setting aside the “during a post op” argument the rest of the definition does a nice job conveying what is truly happening.
Again, one can debate this opinion and we can still be friends . This also could be payer specific in regard to what modifier you might use.

Question: When do you bill immunohistochemistry?
Answer: Per CPT guidelines (see notations under the descriptors for 88314) “Do not report 88314 with 17311-17315 for routine frozen section stain [eg, hematoxylin and eosin, toluidine blue], performed during Mohs surgery. When a non-routine histochemical stain on frozen tissue during Mohs surgery is utilized, report 88314 with modifier 59. Report one unit of 88314 for each special stain on each frozen surgical pathology block.”

Question: How do you bill Mohs with 16 sections?
Answer: If sections refer to blocks, and the 16 blocks are all in the same stage then you could bill your regular Mohs surgery codes for the number of stages you perform and you would bill 17315 for the 11 blocks above the 5 allowed for in a stage. So 17315 for 11 units.

Question: Will you be addressing slow Mohs?
Answer: I think I eventually got around to discussing slow Mohs. If your definition of slow Mohs is that an excision is performed and the specimens are then sent to a lab and read, then this isn’t Mohs at all because the physician is not acting as surgeon and pathologist. This would then be billed as an excision.
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