Mohs surgery, also known as chemosurgery, created by a general surgeon, Dr. Frederic E. Mohs, is performed to remove complex or ill-defined cutaneous malignancy.
List Of CPT Codes For Mohs Surgery
CPT Code 17311 and CPT Code 17313 are the base codes for the range of this surgery. CPT Code 17312, CPT Code 17314 and CPT Code 17315 are the add-on codes for this range.
CPT 17311 Description
CPT 17311 can be reported for Moh’s micrographic technique, including removal of all gross tumor, surgical excision to tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg. Hematoxylin and eosin, toluidine blue), head, neck, hands, feet genitalia, or any location with surgery directly involving muscle, cartilage, bone, tendon, major nerves, or vessels; first stage, up to 5 tissue blocks.
CPT 17312 Description (addon)
CPT 17312 is an addon code for each additional stage after the first stage, up to 5 tissue blocks (List separately in addition to code for primary procedure)
CPT 17313 Description
CPT 17313 may be reported for Moh’s micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stains(s) (eg. Hematoxylin and eosin, toluidine blue), of the trunk, arms, or legs; first stage, up to 5 tissue blocks.
CPT 17314 Descriptio (addon)
CPT 17314 is an addon code that can be used for each additional stage after the first stage, up to 5 tissue blocks (List separately in addition to code for primary procedure).
CPT Code 17315 Description (addon)
CPT 17315 may be reported for Moh’s micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stains(s) (eg. Hematoxylin and eosin, toluidine blue), each additional block after the first 5 tissue blocks, any stage (List separately in addition to code for primary procedure)
CPT Coding Guidelines For Mohs Micrographic Surgery
Tip: Check the Revised Moh’s Surgery Guidelines for UHC
Report the appropriate Mohs surgery code for the body location surgery performed effected, with include any applicable surgery modifiers and the appropriate quantities for the specimens mapped in the days/units field.
Report CPT Code 17312 for additional stages with first stage CPT Code 17311. Report CPT Code 17314 for additional stages with first stage codes 17313.
All the surgical procedure performed in the same operative session, including repairs should be reported on the same claim.
Do not report multiple instances of CPT Code 17312 and CPT Code 17314 on separate claim lines. These should be totaled and entered as a single item with appropriate units of service greater than one.
For each additional (separate) lesion treated with Mohs surgery on the same day, bill each first stage as a CPT Code 17311 or CPT Code 17313 as appropriate, on a separate claim line with a Modifier 59.
Separately identify the additional stages for these lesions by billing the CPT 17312 or CPT 17314 on separate claim lines with Modifier 59, and the appropriate units of service for these lesions.
If Mohs on a single site cannot be completed on the same day because the patient could not tolerate further surgery and the additional stages were competed the following day, you must start with the primary code (CPT Code 17311) on day two.
Computer edits will reject claims where a secondary code (e.g., CPT Code 17312) is billed without the primary code (e.g., CPT Code 17311) also appearing on same date of service, same claim.
CPT Code 17315 may be used to report each block after the first 5 blocks for any single stage (17315 is used as an add-on code to CPT Code 17311, CPT Code 17312, CPT Code 17313 or CPT Code 17314).
Please note that this code refers to the number of blocks, not number of slides.
Mohs Surgery and Surgical Pathology
The use of CPT Code 17311, CPT Code 117312, CPT Code 117313, CPT Code 117314 and CPT Code 117315 is reserved for the surgeon who removes the lesion and prepares and interprets the pathology slides.
The surgical pathology codes CPT Code 88300, CPT Code 88301, CPT Code 88302, CPT Code 88303, CPT Code 88304, CPT Code 88305, CPT Code 88306, CPT Code 88307, CPT Code 88308, CPT Code 88309, CPT Code 88331, CPT Code 88332 and CPT 88342 are part of the Mohs surgery and are bundled into CPT Code 17311, CPT Code 17312, CPT Code 17313, CPT Code 17314, CPT Code 17315.
The surgeon should not append Modifier 59 to these pathology codes unless they pertain to a separate biopsy/excision that does not involve Mohs surgery.
Mohs Surgery and Skin Biopsy
The Mohs micrographic surgery CPT codes include skin biopsy and excision services (CPT Codes 11000 and CPT Code 11001, CPT Code 11600 until CPT code11646, and CPT Code 17260 until CPT Code 17286).
However, if a suspected skin cancer is biopsied for pathologic diagnosis prior to proceeding to Mohs micrographic surgery, the biopsy (CPT Code 11000 and CPT Code 11001) and frozen section pathology (CPT Code 88331) may be reported separately utilizing Modifier 59 or Modifier 58 to distinguish the diagnostic biopsy from the definitive Mohs surgery.
Although the CPT Manual indicates that Modifier 59 should be utilized, it is also acceptable to utilize Modifier 58 to indicate that the diagnostic skin biopsy and Mohs micrographic surgery were staged or planned procedures.
Repairs, grafts, and flaps are separately reportable with the Mohs micrographic surgery CPT codes.
In order to allow separate payment for a biopsy and pathology on the same day as MMS, Modifier 59 is appropriate:
- when the lesion for which Mohs surgery is planned has not been biopsied within the previous 60 days; or
- when the surgeon cannot obtain a pathology report, with reasonable effort, from the referring physician; or
- when the biopsy is performed on a lesion that is not associated with the Mohs surgery.
Reimbursement For Mohs Micrographic Surgery
Claims for Mohs surgery services are payable under Medicare Part B in the following places of service: office (11), inpatient hospital (21), outpatient hospital (22), ambulatory surgery center (24), independent clinic (49), federally qualified health center (50), state or local public health clinic (71) and rural health clinic (72).