AHA Coding Clinic® for HCPCS - 2022 Issue 3; Ask the Editor

MOHs surgery with referral of special stains

A patient with a 1.2 x 0.6 cm squamous cell carcinoma of the right temple presented for Mohs micrographic surgery. At the initial stage, the tumor was debulked/excised along with the peripheral and deep margins. The tissue was mapped and color-coded. The microscopic examination revealed tumor persisting in the deep portion of the specimen; therefore, the patient required additional Mohs stages. In the final stage, stage IV, the surgeon’s microscopic examination of the specimen revealed no additional tumor however, due to perineural inflammation and concern for perineural tumor invasion, the surgeon melted down the tissue block and sent it for special stains to an outside facility. The final defect measured 2.5 x 2.1 cm and the patient was referred to plastic surgery for closure. Given Mohs codes may only be reported when the physician operates as both surgeon and pathologist, does sending tissue for special stains (after the surgeon has reviewed) negate the option for reporting codes from the Mohs surgery code range 17311-17315? What are the appropriate CPT codes the facility should report for this case? ...

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