Revised Moh's Surgery (MMS- Mohs Micrographic Surgery) Guidelines:
The mentioned below updates are effective from dates of service on and after Sept. 1, 2019.
According to CMS, Mohs surgery should only be performed by a "doctor of medicine (MD) or doctor of osteopathic medicine (DO)" who is specifically trained and highly skilled in Mohs techniques and pathologic identification
In order to maintain the quality of care and services delivered to our members, UnitedHealthcare will only reimburse Mohs surgery to an MD or DO who is specifically trained in both dermatology and pathology
If either the removal of the tumor or the pathology is delegated to another physician or other qualified health care professional, not under the same tax ID number, the Mohs code will be denied.
CMS guidance indicates that pathology examination of the tissue specimen is an inclusive component of Mohs and should not be reported separately.
Accordingly, UnitedHealthcare will deny the pathology examination, if separately reported.
Source: New Guidelines for Mohs Surgery
Blogger Widget
Popular Posts
-
Modifier - as the name implies a modifier will modify a service / procedure or an item under certain circumstances for appropriate reimbur...
-
An OPPS payment status indicator is assigned to every HCPCS code. The status indicator identifies whether the service described by the H...
-
This procedure is medically necessary only when it requires the professional skills of a therapist, is designed to address specific ne...
-
Claim Adjustment Reason Codes (CARC) CO-22 or PR-22 This care may be covered by another payer per coordination of benefits. CO-19 This is...
-
Mohs surgery, also known as chemosurgery, created by a general surgeon, Dr. Frederic E. Mohs, is performed to remove complex or ill-defi...
-
Definition: The “-59” modifier is used to indicate a distinct procedural service. The physician may need to indicate that a procedure or...
-
Ambulance transportation is a covered service when the patient’s condition is such that the use of any other method of transportation would...
-
This procedure may be medically necessary for training patients whose walking abilities have been impaired by neurological, muscular, o...
-
AAPC’s Certified Professional Coder (CPC) credential is the gold standard for medical coding in physician office settings and held by more ...
-
Sentinel lymph node identification and biopsy typically involves a multidisciplinary approach. A nuclear medicine procedure called lymph...
