CurrentHighmark Blueshield NenyPolicy N/A

Mohs micrographic surgery coding and billing

Defines coding, documentation, and billing guidance for Mohs micrographic surgery (CPT 17311-17315) and associated pathology reporting for Highmark BlueShield providers in applicable states.

Policy Summary

PayerHighmark Blueshield Neny

PolicyMohs micrographic surgery coding and billing

Policy CodePolicy N/A

Change TypeNo material change

Effective DateSep 1, 2024

Next Review DateN/A

Key ActionDo not separately report surgical pathology codes for tissue used for Mohs margin evaluation when the surgeon performs the pathology.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

17311-17315Mohs surgery codes covered

88302-88309,88331-88332Pathology codes referenced

Same physicianSame physician requirement

States listedState cross-reference

Mohs Billing & Documentation Criteria

Mohs billing and documentation criteria

Billing and documentation criteria for Mohs and related pathology:

Covered when ALL of the following documentation and billing conditions are met:

ALL of the following

Pathology reporting tied to Mohs: Do not separately report surgical pathology CPT codes 88302-88309 or 88331-88332 for tissue used for margin evaluation during Mohs when the performing surgeon also performs the pathology; if the specimen is submitted to an outside pathologist, the performing pathologist should report the pathology service.
Documentation must clearly note lesion location, number of stages required for each lesion, number of blocks per stage, and the complexity and size of each lesion.
Documentation must support that the same physician performed both the surgical excision (Mohs) and the pathologic examination when pathology is not separately reported.

Policy Summary

PayerHighmark Blueshield Neny

PolicyMohs micrographic surgery coding and billing

Policy CodePolicy N/A

Change TypeNo material change

Effective DateSep 1, 2024

Next Review DateN/A

Key ActionDo not separately report surgical pathology codes for tissue used for Mohs margin evaluation when the surgeon performs the pathology.

SourceLink

On This Page

Procedure and Pathology Codes

Mohs surgery CPT codesCPTCovered

17311-17315

Mohs micrographic surgery codes (by lesion location and number of blocks)

Pathology CPT codesCPT

88302-88309	Surgical pathology—should not be reported separately for tissue used for Mohs margin evaluation when performed by the surgeon
88331-88332	Pathology codes referenced for surgical pathology reporting

Documentation required

Number of stagesDocument the number of stages required for each lesion excised

Blocks per stageRecord how many blocks the physician divided each stage into

Lesion locationDocument lesion location (used to determine Mohs CPT code 17311-17315)

Lesion size and complexityInclude lesion size and complexity for each excised lesion

Same physician performed surgery and pathologyDocumentation must support that the same physician performed both the surgical and pathology services; if submitted to an outside pathologist, that pathologist reports the pathology

Billing Rules and Reporting Guidance

Billing Rule

Do not separately report surgical pathology for Mohs margin tissue

Do not separately report surgical pathology CPT codes 88302-88309 or 88331-88332 for tissue used for margin evaluation during Mohs when the surgeon performs the pathologic examination. If the specimen is submitted to an outside pathologist for frozen or permanent section, that performing pathologist should report the pathology service and the surgeon should report the excision and repair using appropriate CPT codes.

Billing Rule

Modifier -59 not appropriate for biopsy and Mohs on same lesion/session/date

Do not append modifier -59 when the biopsy and Mohs are performed on the same lesion in the same operative session on the same date of service. Modifier -59 may be appropriate if the submitted tissue is not the same tissue processed during Mohs or when a diagnostic biopsy precedes Mohs and the biopsy/frozen section pathology are reported separately.

Key Terms

Stage — definition

DefinitionA stage is one cycle of tissue removal and examination during Mohs surgery; successive stages are performed and examined until margins are clear

Relation to blocksEach stage may be divided into multiple blocks that are mapped and examined microscopically

Role of physicianStages are performed with the physician removing tissue (surgeon) and examining blocks (pathologist) as part of the Mohs technique

Block — definition

DefinitionA block is a portion of the excised specimen divided for mapping and microscopic examination within a stage

Use in codingMohs CPT codes are built based on lesion location and the number of required tissue blocks (not the number of slides)

MappingEach block's location within a stage is carefully mapped for margin evaluation and potential additional excision