Billing and Coding for Pathology Services on the Same Date of Service (DOS) as Mohs Surgery

The Billing and Coding for Pathology Services on the Same Date of Service (DOS) as Mohs Surgery has been created and published for notice under contract numbers: 01112 (NCA), 01182 (SCA), 01212 (AS, GU, HI, NMI) and 01312 (NV).

Effective Date: January 1, 2018
Article Summary: This article instructs providers that reporting both Mohs Micrographic Surgery CPT® codes 17311-17315 and Surgical Pathology CPT® 88302-88309, 88331-88332, 88341-88342 or 88344 on tissue used for margin evaluation during Mohs surgery is inappropriate and the Mohs surgery codes will be denied. To allow separate payment for a nonroutine histochemical stain on frozen tissue during Mohs surgery, report 88314 with modifier 59.

There are occasional clinical situations in which tissue separate from the tissue examined during Mohs surgery is appropriately submitted for subsequent formalin fixed processing and histopathologic examination. The submitted tissue is not the same tissue that was processed during the Mohs surgery, thus is subject to separate coverage. In such cases the clinical record must clearly show the reasoning for the histopathologic specimen and interpretation and billed with modifier 59.

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Last Updated May 09, 2019