Coding a Flap after Mohs Surgery

Question:

A patient was seen by a dermatologist in their clinic for a MOHS procedure. After completion of MOHS, the patient went to the ambulatory surgical center for our ENT provider to perform CPT 14060. Since the ENT did not perform the MOHS excision but did perform the flap, would a 52 modifier have been appropriate since the opening excision was performed by a different specialty at a different location?

Answer:

Thank you for your question. Modifier 52 (Reduced Services) is only used when the same provider performs a service but reduces or does not complete the full work of the CPT code.

In this case your ENT did perform the full flap procedure described by CPT 14060. The fact that a different specialty performed the Mohs excision beforehand does not mean your ENT performed a reduced service. The ENT was not expected to perform the excision because the Mohs surgeon already did it. The flap reconstruction can be billed by ENT without a modifier.

*This response is based on the best information available as of 02/05/26.

Reporting an E/M Service on the Same Date as Mohs Surgery

Question:

I code for 2 Mohs surgeons and I am confused about whether or not we can code for an E/M service on the same day as Mohs. Here is the situation: The patient is referred by an outside Dermatologist and scheduled for Mohs surgery with one of our Mohs surgeons. The patient brings in a biopsy that was performed the previous week. Can we bill a new patient E/M visit since the physician has to evaluate the patient before performing Mohs?

Answer:

If the patient has been scheduled for Mohs surgery and the evaluation performed is the routine preoperative assessment necessary to perform the procedure, do not bill the E/M service. The E/M service is inherent to Mohs surgery. The E/M service is only billable if it goes beyond the inherent preoperative work, meaning it must be significant and separately identifiable and well documented in the medical record.

*This response is based on the best information available as of 01/22/26.

History of Skin Cancer — Low or Moderate Complexity

Question:

I have a question about history of skin cancer and the complexity of the problem. If a patient comes in for follow up for history of skin cancer and the physician does a full skin exam, is the complexity low or moderate?

Answer:

Thank you for your question. The history of skin cancer is considered a chronic condition. However, the determination between low complexity and moderate depends on the condition. If the physician exams the patient and there is no evidence of a recurrence the complexity is low (chronic stable). But if the physician discovers another skin cancer or suspects cancer, the complexity is now moderate (chronic, exacerbating). Keep in mind the complexity of the problem addressed is only one element. There are two other elements, amount and/or complexity data to be reviewed and analyzed and risk of complications and/or morbidity or mortality of patient management which goes into determining the overall level of service. Two of the three elements must be met when determining the level of service based on medical decision making.

*This response is based on the best information available as of 01/08/26.

Does a Figure-Eight Suture Qualify as Intermediate Repair?

Question:

I was told a figure eight suture is considered intermediate closure. Is this correct?

Answer:

A figure-eight suture is just a closure technique, not a repair classification. The depth of the wound and layers repaired determine whether the closure is coded as simple, intermediate, or complex.

*This response is based on the best information available as of 12/18/25.

Benign Lesion Destruction

Question:

My provider destroyed 5 lesions on the penis, and then 5 lesions on the scrotum and groin area. Can I code 54056 and 17110?

Answer:

Thank you for your question. The destruction of the lesions on the penis are via cryosurgery you will report CPT code 54056. In addition, you may report CPT 17110 for the lesion destructions on the scrotum and groin area. Since the two services are not bundled under NCCI Modifier 51 should be appended to CPT code 17110

*This response is based on the best information available as of 12/04/25.

Electrodessication with curettage (ED&C) Measurement

Question:

Good Afternoon, please clarify how lesions are measured for the destruction of malignant lesion codes 17260-17286. Is the code selection based on the size of the lesion before or after the curettage?

We are unable to find guidance from AMA or CMS. Our provider is stating that it is based on the size after curettage and basing it on this article at this link:
www.hmpgloballearningnetwork.com/site/thederm/site/cathlab/event/size-matters#:~:text=Size After Curettage, but Before,a 1.5 cm/d measurement.

Answer:

For destruction of malignant lesion codes 17260-17286, the code selection is based on the size of the lesion AFTER curettage, but BEFORE electrodesiccation.

Destruction of malignant lesions (CPT codes 17260 to 17286) is selected based on the lesion size after curettage, but before electrodesiccation. This timing is important because:

1. Initial clinical appearance may be misleading - The lesion might appear to be a certain size clinically, but curettage helps visualize the true extent of the malignant tissue.

2. Curettage reveals actual lesion boundaries - After curettage, the physician can better assess the actual diameter of the lesion that needs to be destroyed.

3. Before electrodesiccation - The measurement should be taken after curettage but before the electrodesiccation (destruction) process begins, as the destruction process itself would alter the lesion size.

*This response is based on the best information available as of 11/20/25.