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Coding for Dermpath following Mohs surgery

Lena Posted Wed 28th of August, 2019 11:28:38 AM
We have a provider who performs Mohs Surgeries to patients in the dermatology department. He does both the surgical excision of tissue specimens and works as a pathologist. He bills Mohs procedures with cpt codes 17311-17315. However, there are occasions, when specimen is submitted to Dermpath. Example: "Upon review of the horizontal frozen sections for Stage 1, residual tumor was seen in piece A5. Lymphocytic inflammation/atypical keratinocytes were noted in piece A5. This specimen was submitted for permanent section consultation in accordance with the below note. STAGE II - The area thus outlined was excised at the level of bone using a periosteal elevator. Hemostasis was achieved with electrocautery. The specimen was oriented, maintained in 1 section, chromacoded and submitted for horizontal frozen sections. The patient tolerated the procedure well and no complications were noted. Upon review of the horizontal frozen sections for Stage 2, no residual tumor was seen. I have personally reviewed the specimens and worked as the pathologist. Mohs surgery with frozen section tissue processing is highly effective for the delineation of tumor margins. In a small minority of cases, further paraffin (formalin-fixed) section pathologic evaluation may be necessary for optimal patient care. This may occur before, during, or after the Mohs procedure. The squamous cell carcinoma was removed by Mohs surgery and all margins were interpreted by me. The central tumor debulk and one first block was sent for permanent sections for staging and further evaluation of the atypical lymphocytes/keratinocyites seen on frozen section slides. You will see a separate pathology billing from pathology which is appropriate in this case". What code(s) can the Dermpath lab bill, if any, for testing the specimen submitted after Mohs surgery in the example provided above? Thank you for your help.
SuperCoder Answered Thu 29th of August, 2019 02:48:38 AM

Hi Lena,

Mohs codes such as 17311-17315 specifically include “histopathologic preparation including routine stain.” So, if the work is divided, you may need to coordinate with the surgeon to determine proper coding (excision for the surgeon, pathology for the lab, rather than using Mohs codes).

CPT guidelines with the 1731x codes state, Mohs “requires a single physician to act in two integrated but separate and distinct capacities: surgeon and pathologist. If either of these responsibilities is delegated to another physician who reports the services separately, these codes should not be reported.”

“THE USE OF CPT CODES IN THE 173XX SERIES IS RESERVED FOR THE SURGEON WHO REMOVES THE LESION AND PREPARES AND INTERPRETS THE PATHOLOGY SLIDES. The surgical pathology codes in the 883xx series are part of the MMS and are bundled into the 173xx codes. The surgeon should not append Modifier 59 to these pathology codes unless they pertain to a biopsy/excision that does not involve MMS. … If the preparation and interpretation of the slides of tissue taken during the MMS are performed by someone other than the surgeon or his or her employee, then MMS surgery may not be billed.

NOTE:  If the surgeon removes tissue and sends it to your lab, he should bill lesion excision (such as 11643, Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1 to 3.0 cm) not Mohs. And you should bill the appropriate surgical pathology code such as 88305 (Level IV - Surgical pathology, gross and microscopic examination, Skin, other than cyst/tag/debridement/plastic repair) or 88331 (Pathology consultation during surgery; first tissue block, with frozen section[s], single specimen).

However, in your case scenario, no extra code will be billed, because the surgeon performs the pathology on the Mohs specimen.

Feel free to ask for any further query.

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