Mohs Coding Dilemma
Question:
I am new in Dermatology coding and am currently coding for a Mohs surgeon. I was instructed that if the patient comes in and does not have a confirmed malignancy based on a pathology report and the physician does a biopsy to confirm the malignancy prior to Mohs surgery we can bill 88311 for pathology and the Mohs procedure on the same date. Is this correct?
Answer:
If there is not a pathology report that confirms the patient has a malignancy and meets the criteria for Mohs surgery then you can report Mohs (17311-17315) based on the anatomic area, and stage performed and 88311-59. You must use a 59 modifier because the Mohs procedure codes and 88311 are bundled under the National Correct Coding Initiative. CMS states, “The surgical pathology codes 88300-88309 and 88331-88332 and 88342 are part of the Mohs surgery and are bundled into 17311-17315. One exception is that it would be appropriate to report 88311 with Modifier 59 if a pathology report does not exist for the patient or the pathology report is 60 days or older or cannot obtained (CMS). Keep in mind Code 88311 (Surgical Pathology, gross and microscopic examination) for the preparation and interpretation of the slides taken during the procedure is included in the Mohs procedure codes. Do not forget to also report the appropriate biopsy code with Modifier 59.
Two CMS reference might be helpful for you to review below.
CMS Mohs reference:https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1318.pdf.
*This response is based on the best information available as of 06/30/22.
