October 13, 2016

Question:
I am having trouble coding the following situation. A new patient was referred by a general dermatologist to our Moh’s surgeon with a suspicious lesion on the chest. A biopsy had not been previously performed and my surgeon performed a punch biopsy of the lesion, prepared the specimen for frozen section and determined the lesion was positive for basal cell carcinoma of the chest. On the same day he bills 17313 for a one-stage Moh’s procedure on the chest. Can I bill for the biopsy and Moh’s on the same date or is it included in the procedure?

Answer:
The surgical pathology codes 88300-88309 and 88331-88332 and 88342 are part of the Moh’s surgery and are bundled into 17311-17315. The surgeon should not append Modifier 59 to these pathology codes unless they pertain to a separate biopsy/excision that does not involve Moh’s surgery.

However there are certain conditions in which Moh’s and a biopsy can be reported on the same date in any of these instances:

• When the lesion for which Moh’s surgery is planned has not been biopsied within the previous 60 days.

• When the surgeon cannot obtain a pathology report, with reasonable effort, from the referring physician.

• When the biopsy is performed on a lesion that is not associated with the Moh’s surgery.

In the situation you described since a previous biopsy was not performed in the past 60 days you can report the Moh’s procedure with the biopsy and frozen section. You should report 17313 (Moh’s surgery stage 1 of chest), 11100-59 (biopsy) and 88331-59 (frozen section). Make sure you append modifier 59 on the biopsy and frozen section to identify they are distinct and separate from the Moh’s surgery.

*This response is based on the best information available as of 10/13/16.