Biopsy on the Same Date as Mohs

Question:

A patient came in for Mohs surgery, but there was no pathology report, so I had to do a biopsy before Mohs surgery.  Can I report the biopsy on the same date as the Mohs surgery?

Answer:

It is standard practice that a confirmed pathology report is available before Mohs surgery. You can bill a biopsy code on the same date as Mohs under the following conditions: 

• There is no previous biopsy on the same lesion within 60 days. 

• No pathology report available. 

• When biopsy and Mohs procedure are on separate sites. 

Ensure that a pathology report that does not exist or cannot be located is well documented.  In addition, You would report a biopsy code 11102, 11104, or 11106, depending on the biopsy method, plus 88331 for the frozen section pathology. Modifier 59 needs to be appended to each code to indicate that the biopsy was distinct and separate.   

*This response is based on the best information available as of 3/14/24.

Repairs following Mohs Surgery

Question:

Our Mohs surgeons will sometimes perform an adjacent tissue transfer or a flap after Mohs surgery.  They want to bill an E/M service with Modifier 57 since they decided to do the flap after Mohs.  I don’t think this is correct.  Can you help clarify?

Answer:

The E/M service should not be reported after Mohs surgery when a decision is made for a repair, flap, or graft.  Even though a flap has a 90-day global period, the surgical decision was made to perform Mohs, the primary procedure.  The intent of the E/M with Modifier 57 for a procedure with a 90 global period is when the initial decision is made to perform the primary procedure.  The repair is secondary; therefore, billing an E/M service is inappropriate.  The discussion and recommendation for the repair is part of the pre-service work for the repair.

*This response is based on the best information available as of 2/29/24.

Seborrheic Keratosis

Question:

What diagnosis code would I use to report a seborrheic keratosis? 

Answer:

Seborrheic Keratoses are benign lesions. The typical diagnosis is L82.1 (other seborrheic keratosis) but if inflamed the correct diagnosis is L82.0 (inflamed seborrheic keratosis).

*This response is based on the best information available as of 2/15/24.

Coding Question on a Diagnosis

Question:

What is Actinic Keratosis and what procedure is used to treat this condition?

Answer:

Actinic Keratoses is an extremely common dermatological condition among the elderly. It is suspected to be a pre-malignant condition. The condition presents as rough, sometimes red, scaly patches on the skin, typically where there has been exposure from the sun. Common areas are the face, scalp, neck, ears, forearms, and hands. While they are mostly benign lesions, most squamous cell carcinomas begin as actinic keratoses, making it preferable to remove or destroy them before it can progress into malignancy. Treatment for Actinic Keratoses is cryotherapy which is a destruction.

The procedure to destroy or remove actinic keratoses are generally covered by Medicare and commercial payers. The CPT code to report actinic keratosis destruction is 17000 for the first lesion, 17003 for the second through 14th lesions (each lesion) and 17004 for 15 lesions or more and is reported only once. The diagnosis code for Actinic Keratosis is L57.0.

*This response is based on the best information available as of 2/1/24.

Procedure Coding

Question:

What is the difference between a biopsy and removal when it comes to dermatology.

Answer:

A biopsy is a sample of a suspicious lesion on the body and the tissue is sent to a laboratory for testing. Where shave excisions are removals of lesions without taking the full thickness of the skin. These codes include local anesthesia. The wounds do not require suture closure.

*This response is based on the best information available as of 12/28/23.

Time Reporting for E/M Levels

Question:

My physician is billing office visits 99202-99215 based on time only.  Is this best practice?

Answer:

The E/M services 99202-99205 are based on either medical decision making or time..  Practitioners may choose to either bill by time or medical decision making.  The practitioner should evaluate each patient encounter to determine which method is more advantageous.  If time is used to calculate the E/M service, the total time should include all work associated with the patient encounter on the date of service.  KZA recommends that the practitioner document an attestation statement itemizing the time spent on the specific activities for the patient.  Example:. “This encounter took 45 minutes of time including taking a history, performing the examination, reviewing the CT scan, reviewing the PCP’s notes, counseling the patient on the conditions treated formulating a plan of care as well as documenting in the EHR.”

*This response is based on the best information available as of 12/14/23.