Medicare Mohs ruling isn't universal

June 1, 2007

Q I know that Medicare has reversed its decision to apply the Multiple Surgery Reduction Rule (MSRR) for Mohs codes retroactive to Jan. 1, 2007. My question is that many of my non-Medicare, commercial carriers are still reducing the Mohs and/or the repair if performed on the same date of service. What can I do to get them to comply with the Medicare rules? - Reduced To Tears

Q I know that Medicare has reversed its decision to apply the Multiple Surgery Reduction Rule (MSRR) for Mohs codes retroactive to Jan. 1, 2007. My question is that many of my non-Medicare, commercial carriers are still reducing the Mohs and/or the repair if performed on the same date of service. What can I do to get them to comply with the Medicare rules?- Reduced To Tears

A Dear Reduced: Unfortunately, the CMS ruling about the exemption for Mohs applies to federal programs only. The commercial carriers do not have to comply with the exemption. You have just three options that I can see:

1. Drop the plan.

3. Live with it.

Q I would like to know which CPT code we use for phototherapy. This treatment would be used to treat psoriasis and vitiligo. What code do you suggest and is the code reimbursable by insurance carriers?- Shine the Light

A Dear Shine: The first questions I would pose to you before I can respond to those questions are:

"Are you using tar or petrolatum in conjunction with the light treatment?"

If you are, then you can use CPT code 96910. (This would involve ultraviolet B light.)

"Is the patient being prescribed with psoralens in conjunction with ultraviolet A (UVA) light therapy?"

If so, then you can use CPT code 96912. If you don't use tars, petrolatum or psoralens with the light treatment, then the only CPT code available is 96900. Using either CPT codes 96910 or 96912 when only a light source is used is a misrepresentation of your services and could constitute a fraudulent claim under the Federal False Claims Act.

Most insurance carriers cover CPT code 96900 and usually don't have too many restrictions on this code since it only pays about $20. (This is the Medicare allowable. Commercial carriers may pay a little bit more.)

The Medicare reimbursement for CPT code 96910 is approximately $50, with CPT code 96912 paying about $62.

Q We do Mohs in our office. It is not uncommon for the Mohs surgeon to perform a biopsy of the lesion prior to doing the Mohs. (This is usually because we don't have a biopsy report or we are unsure of the type of lesion we are dealing with.) How do I bill for this frozen section prior to Mohs? Will it be reimbursed? Do I need modifiers?- Frozen With Fear

A Dear Frozen: Yes, you can bill for the biopsy as well as the frozen section. Bill the frozen section using CPT code 88331 for the first specimen and CPT code 88332 (in units) for each frozen section thereafter.

The biopsy would be billed, of course, using CPT code 11100. You will not get paid for the frozen section without including CPT code 11100. Both codes need modifier 59 in order to override the denial edit.

Q What is the ICD-9-CM code for family history of malignant melanoma? We frequently see patients who don't personally have malignant melanoma, but have bad family history that makes them high-risk. Will insurance cover this ICD-9-CM code as the primary diagnosis?- Risky Business

A Dear Risky: The ICD-9-CM code for family history of malignant melanoma is V16.8, which is not a covered primary diagnosis. I would not use this on the claim form. Use the diagnosis(es) for the skin lesions that were reviewed upon examination, such as nevi, seborrheic keratosis and so on, even if the lesions are asymptomatic and do not require treatment. The fact that you examined the lesion and made the decision that no treatment was needed is a medical decision. Those diagnoses would be the ones used to support the E/M visit.

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