Billing and Coding: Mohs Micrographic Surgery

Mohs micrographic surgery is covered when documentation demonstrates that lesion complexity, size, or location necessitate Mohs rather than simple excision and when the procedure is performed using accepted Mohs technique with the same physician performing surgical and pathology services. Claims must include a valid ICD-10-CM diagnosis code and robust medical record documentation (assessment, history, signed operative reports, lesion details, stages and specimens); special billing modifiers and ABN rules (-GA, -GX, -GZ, -GY) and NCCI/OPPS edits apply. A same-day biopsy billed with -59 is allowed only under strict conditions (different lesion, no prior biopsy within 60 days, or unobtainable prior results).

"Mohs micrographic surgery is covered when the medical record documents that the lesion's complexity, size, and/or location make Mohs more appropriate than simple excision or destruction techniques."