Billing and Coding: Mohs Micrographic Surgery

Mohs Micrographic Surgery is covered for complex or ill-defined skin cancers when 100% margin histologic examination is performed and the same physician provides both the surgical and histologic services. Claims must document the medical necessity (complexity, size, location), operative details (lesion location/size/number, stages, specimens), and first-stage histology; reporting both MMS codes and surgical pathology on the same tissue used for margin evaluation is not allowed and will be denied. Separate pathology for unrelated or separate tissue may be covered with clear documentation, and nonroutine frozen-tissue stains can be billed as CPT 88314 with modifier -59; prior biopsies within 60 days should be used rather than routinely repeating the biopsy.

"Mohs Micrographic Surgery (MMS) is covered for removal of complex or ill-defined skin cancer when 100% of the surgical margins are histologically examined and the same physician performs both the s..."