Mountain State Medical Policy Bulletin
Section: Surgery
Number: S-46
Topic: Mohs Chemosurgery
Effective Date: August 1, 2005
Issued Date: August 1, 2005
Date Last Reviewed: 06/2005

General Policy Guidelines

Indications and Limitations of Coverage

Mohs chemosurgery involves multiple layered excision of skin carcinoma with or without the application of chemicals to the excised area. Each excised layer of tissue is divided into multiple specimens which are stained, frozen sectioned, and microscopically examined by the surgeon.

The following codes should be used to report Mohs chemosurgery:

  • Procedure code 17304 should be used to report the first stage of Moh's surgery.  This service includes the removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and complete histopathologic preparation including the first routine stain, up to 5 specimens.
  • Procedure codes 17305 and 17306 should be used to report the second and third stages of surgery, fixed or fresh tissue which also includes up to 5 specimens each.
  • Procedure code 17307 should be used to report additional stages after the third stage, up to 5 specimens for each additional stage.
  • Procedure code 17310 should be reported for each additional specimen, after the first 5 specimens, fixed or fresh tissue.  This code represents additional specimens at all stages of the Mohs surgery. 

Multiple surgery reductions are not applied to codes 17304-17310.

Separate payment can be made for a repair, flap or skin graft following Mohs chemosurgery.

A presurgical biopsy may be necessary to establish a diagnosis. When reported on the same day with Mohs chemosurgery, the presurgical biopsy should be processed under code 11100 and the frozen section should be processed under procedure code 88331.

Payment may be made for the presurgical biopsies of multiple lesions if documentation shows that the biopsies were performed on separate lesions.

Subsequent biopsies of additional tissue blocks, procedure code 88332, should not be reported separately. These additional frozen sections (88332) reported with the Mohs chemosurgery should be combined with codes 17304-17310. Additionally, all other surgical pathology services reported with Mohs should be combined and processed under the appropriate procedure code, 17304-17310. A participating, preferred, or network provider cannot bill the member for these additional pathology services.

Procedure Codes

111001730417305173061730717310
8833188332    

Traditional Guidelines

Refer to General Policy Guidelines

FEP Guidelines

Refer to General Policy Guidelines

PPO Guidelines

Refer to General Policy Guidelines

Managed Care POS Guidelines

Refer to General Policy Guidelines

Publications

References

Mohs micrographic surgery, Journal of the American Academy of Dermatology, Vol. 39, No. 1, July 1998

Mohs micrographic surgery for basal cell carcinoma, Clinical and Experimental Dermatology, Vol. 24, December 1998

Mohs'98: Single-procedure Mohs surgery with immediate reconstruction, Otolaryngology Head and Neck Surgery, Vol. 120, No. 2, February 1998

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Glossary




This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.

Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Mountain State Blue Cross Blue Shield plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.

Mountain State Blue Cross Blue Shield (MSBCBS) retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of MSBCBS. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.