Mohs micrographic surgery — coding, documentation, and billing guidance
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Defines coding, documentation, and billing guidance for Mohs micrographic surgery (CPT 17311-17315) and related pathology codes for Highmark Blue Shield members; affects providers submitting claims in the listed service areas (includes state-specific notes).
No material clinical or coverage changes in this revision.
Mohs Coverage and Billing Criteria
Mohs coverage and billing criteria
Coverage and billing stance for Mohs and associated pathology services:
Exceptions
- If the Mohs surgeon submits specimen(s) from the procedure to another physician (pathologist) for frozen or permanent section, those pathology services may be reported separately by the receiving pathologist; in such situations the service provided by the receiving provider is not considered Mohs and appropriate excision/repair codes should be used by that provider.
- When biopsy tissue is different from the tissue processed during Mohs, or when a diagnostic biopsy occurred prior to Mohs, modifier -59 may be appended to the pathology code to report the biopsy/frozen section separately.
Mohs and Related Pathology Coding & Documentation
| 17311-17315 | Mohs micrographic surgical excision codes (by lesion location/number of blocks) |
| 88302-88309 | Pathologic examination codes — generally not reported separately when used for Mohs margin evaluation |
| 88331-88332 | Additional pathology codes potentially used when specimens are sent to another pathologist |
| -59 | Modifier -59 may be appended to pathology code when biopsy tissue is different from tissue processed during Mohs or when biopsy occurred prior to Mohs |
Billing and Documentation Requirements for Providers
Billing/documentation requirements for Mohs and pathology
Do not report surgical pathology CPT codes (88302-88309 or 88331-88332) separately from Mohs surgical codes (17311-17315) for tissue used for margin evaluation during Mohs; documentation must show the number of stages, number of blocks per stage, lesion size/complexity, lesion location, and that the same physician performed both the surgical and pathology services.
- If specimens are sent to another pathologist for frozen or permanent section, the receiving pathologist may report pathology services separately; in that case the service is not considered Mohs for the receiving provider and appropriate excision/repair codes should be used.
- Modifier -59 should not be used to separate biopsy and Mohs when the submitted tissue is the same as that processed during Mohs; -59 may be appended when the biopsy tissue is different or when a diagnostic biopsy occurred prior to Mohs.
Key Definitions
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