Billing Stages for Mohs

Question:

I am very confused. I am new to coding for Mohs procedures. The Mohs surgeon performed a procedure on the patient’s scalp in 5 stages. I spoke with the Mohs surgeon about billing over 4 stages in one area using CPT code 17312. He billed 17311 for the first stage and 17312 with 4 units for a total of 5 stages. In each stage, the documentation states that 1 tissue block was mapped. I think we should bill CPT 17315 for the last stage instead of 17312 since it is the 5th stage. Can you clarify if this is the case or if 17312 with 4 units is correct.

Answer:

I agree with your Mohs surgeon. The only time you use 17315 is when there are more than 5 tissue blocks per stage. Based on the information you have provided each stage indicates 1 block. CPT code 17311 should be reported for stage 1 and 17312 is reported for each additional stage (4).

*This response is based on the best information available as of 2/27/25.

Skin Cancer Screening

Question:

What is the correct ICD-10-CM code for a skin screening exam for a patient who has a history of malignant melanoma?

Answer:

You should report 2 diagnosis codes; ICD-10-CM Z12.83 for the encounter for malignant neoplasm of skin and Z25.820 (personal history of malignant melanoma of skin).

*This response is based on the best information available as of 2/13/25.

Is Scar Revision Still Complex Closure?

Question:

I have a scar revision for the abdomen and was going to assign CPT 13101. My coding teammate told me this is no longer the current coding recommendation. Is scar revision still reported with complex closure?

Answer:

Thank you for your inquiry!

Yes, your fellow coder is correct. At one point, CPT did include scar revision within the complex closure guidelines. However, in 2020, the guidelines associated with closures were changed, and scar revision was removed from the complex closure definition.

To address this change, a coding tip was placed within the CPT book in 2020 stating: “To report scar revision, see the Skin, Subcutaneous, and Accessory Structures, Excision-Benign Lesion subsection codes (11400-11471).”

According to CPT guidelines, scar revision is no longer reported with complex wound closure. Coding recommendations and guidelines are subject to change, so coders must review them and utilize up-to-date coding resources.

*This response is based on the best information available as of 1/30/25.

Number and Complexity of Problems Addressed

Question:

I see a number of patients with chronic problems such as dermatitis, psoriasis, history of skin cancer and acne to name a few. What defines stable versus exacerbation or progression?

Answer:

Based on the AMA CPT guidelines a chronic illness is expected to last at least a year or until the death of the patient. You as the practitioner determines when a condition becomes chronic. Of course, there are many conditions that are chronic by the nature of the disease. A stable chronic illness is defined by the specific treatment goals of each individual patient. A patient who is not at treatment goal, not responding to treatment, condition failing to improve, etc. is not stable.

If the patient has a chronic illness with exacerbation, progression or side effect of treatment or inadequately controlled, this would be considered a chronic illness with exacerbation or progression. Typically, a condition exacerbating will require a change or modification in the plan of care. It is important for each problem addressed the practitioner documents the complexity of the problem (stable, chronic, acute, uncomplicated) and the status of the condition (at treatment goal, inadequately controlled, worsening, improving) to paint a clear picture of the condition.

*This response is based on the best information available as of 1/16/25.

History and Examination requirement for E/M services

Question:

I have been practicing for many years and am confused about the E/M guidelines since the changes were made a few years ago, mainly for my office services 99202-99215.  My coder says I should document an history and examination, but I don’t think this is required anymore.  Am I correct?

Answer:

The evaluation and management service levels are no longer determined by history and examination but are based on medical-decision making or Time except for emergency department visit codes (99281-99285), which do not contain a time component. However, a clinically relevant history and examination are required based on the practitioner’s clinical judgment. It is essential to tell the “story” of the patient’s clinical picture in the documentation. The history and examination support the medical necessity for the visit and provide a more complete representation of the patient’s condition for continuity and coordination of care with other clinical practitioners.

*This response is based on the best information available as of 1/2/25.

Which Modifier Should I Use?

Question:

I need some help with using Modifiers. I work for a Mohs surgeon, and he frequently performs Mohs, and the patient comes back differently for a flap or graft. They usually come back within a week. What modifier should I add to the repair when the patient returns?

Answer:

Mohs Micrographic surgery has a global period of “0” days. That means if the patient comes back for the repair on a different date, no modifier is required. 

*This response is based on the best information available as of 12/19/24.