Corina Posted Mon 12th of November, 2012 17:15:05 PM
Our lab prepares the slides for the Mohs surgeon, should they be charging a TC? If so what code?
SuperCoder Answered Mon 19th of November, 2012 20:13:04 PM
Mohs codes such as 17311 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.”
Payers may have similar rules, like this quote from the Novitas LCD (caps added): “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.” (https://www.novitas-solutions.com/policy/mac-ab/l27503-r12.html).
CPT Assistant (November 2006) includes this: "modified" Mohs: A procedure in which the surgeon submits tissue to a pathologist who prepares slides for examination in a manner similar to the Mohs surgeon. Do not report codes17311- 17315 for this staged excision procedure. The surgeon uses appropriate excision and repair codes, and the pathologist reports pathology codes, as appropriate.