Mohs Procedures and Coding – What You Need To Know

Mohs Procedures and Coding – What You Need To Know The practice of dermatology is complex and ever evolving. For some dermatology physicians it may feel like the practice of coding and medical billing is also complex and ever evolving! Coding takes a significant amount of time – in some cases perhaps longer than the procedure for which you are submitting a coded billing. While we hesitate to further compare the importance of a surgical procedure to coding for that procedure, the truth is that coding accurately is crucial to your practice because submitting claims for reimbursement is how you get paid – and in turn how you build a successful and thriving practice. Why is this so important when it comes to Mohs procedures? It’s simple, there’s an added level of complexity and you, along with every member of your staff, should be familiar with Mohs coding considerations to ensure a smooth and timely claims procedure.

What is Mohs?
Perhaps you are familiar with the saying, “If you know you know.” Chances are, you know what a Mohs procedure is but if you are reviewing web based educational materials like this blog and similar, in order to learn more about coding specifically, let’s first talk Mohs. The term “Mohs” is actually the last name of the surgeon who first invented the surgical technique. Frederic Mohs, MD, developed this highly specialized surgical technique to remove certain skin cancers while leaving behind as much healthy tissue as possible. The intent is to potentially minimize scarring and excessive recovery times. Basal cell carcinoma, squamous cell carcinoma and melanoma might all be treated this way. During a Mohs procedure, a suspected tumor is removed, usually while a patient is awake, with a “precise, tissue-sparing, microscopically controlled surgical technique.”

How Mohs Works:
It’s a two-stage technique that must be performed by one surgeon, who acts as both the surgeon and the pathologist, in order for the procedure to qualify and for the coding/billing to be accepted. During the process, the tumor is removed in stages followed by an immediate microscopic/histologic examination of the specimen. Further excision takes place, as necessary, until margins are clear. But, for all of this to be coded accurately and accepted, “the physician performing MMS serves both as surgeon and pathologist; performing not only the excision but also the histologic evaluation of the specimen(s).” This is the only manner in which to ensure your Mohs procedure is coded accurately and qualifies for reimbursement. Surgeons specializing in Mohs (MMS) Micrographic Surgery should also know that Mohs is NOT considered necessary for all skin cancers and if used inappropriately may also see reimbursement claims disqualified. It is most often useful only when:
  • The location of the skin cancer is near areas important for daily functioning (fingers) or for appearance (the nose.)

  • When earlier treatments have not worked.

  • When the tumor is large and/or when regular surgery is less likely to be successful at removing the cancer.

If you conduct and are submitting Mohs for reimbursement you should know that most often, billing / coding problems occur when a different MD completes the pathology analysis or if the analysis takes place on a different day than the procedure itself. Such stringent rules apply because the “majority of skin cancers can be managed by simple excision or destruction techniques” so it’s also particularly critical that you document your patient charts carefully. MMS must be shown to be the most appropriate choice for the treatment of a particular lesion” in order to increase your chances of correct coding and therefore, cost recovery.

Coding is a challenging field. We have purposely not listed the specific codes for MMS Mohs procedures because, as no doubt you are already aware, changes to coding often takes place. Training for every member of your team from the billing surgical practitioner to the front desk staff and any and all persons managing your claims submissions and accounting processes is crucial to ensuring your practice gets paid appropriately for the work performed. Perhaps it’s easier for you to consider outsourcing this work to a team of experts who only deal with codes, all day long every, every day. Derm Care Billing Consultants specialize in dermatology practice billing and our exceptional knowledge is always current and augmented regularly with training and updates for our professional team. We make coding seem simple – that’s our specialty. We’ll leave the skin care up to you!