New CPT codes, new questions

February 1, 2007

With the introduction of new Mohs codes and changes in the definitions of the destruction codes for premalignant and benign lesions, lots of questions and concerns are being generated from not only physicians but their billing staffs as well.

Below are a few of the most commonly asked questions now that the 2007 CPT coding changes are in effect.

Q I know that I will be using the 17000, 17003 and 17004 frequently on the same date of service that either 17110 or 17111 are billed. How will the multiple surgery reduction rule (MSRR) affect these codes? Is CPT code 17004 still exempt from the MSRR for Medicare or will it now be reduced if billed with another service(s) that has a higher allowable?

To answer your question, I'll provide a few more examples. (Note: The fees are based on U.S. general fees and do not reflect actual fees in any specific geographic payment locality.)

Example #1

Example #2

Example #3

Q I do Mohs surgery and am not very happy with the fact that the Mohs codes (e.g., CPT codes 17311 to 17315) are now subject to the MSRR. Here is my thinking. What if I do the Mohs on one day and then have the patient return on the next day to do the repair? Would the repair on the next day be paid at 100 percent? Do I need a modifier? If so, which one? I have been speaking with many of my colleagues and many are considering not only having the patient come back on the next day for the repair, but also limiting the number of cases done on a single date of service. Do you see any problems with these scenarios?

A The Mohs codes have no postoperative days included in the global package. Therefore, if your patient comes back the following day for the repair, no modifier is required and the repair should be paid at 100 percent (assuming no other services were billed on that same date of service).

Keep in mind that only CPT codes 17311 and 17313 are subject to the MSRR. CPT codes 17313, 17314 and 17315 always allowed at 100 percent of the fee schedule amount.