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Issue Number - Name
0150-Mohs Micrographic Surgery (MMS)-Incorrect Units Billed
Review Type
Complex
Claim Type
Professional Services
Region and State
RAC 1-4
All Regions
Date Approved
03/05/2019

Description

MMS is a two-step process in which: 1) The tumor is removed in stages, followed by immediate histologic evaluation of the margins of the specimen(s), and 2) Additional excision and evaluation is performed until all margins are clear. Reviewers will determine if the additional Mohs micrographic technique staging unit(s) for HCPCS 17312 and 17314 is/are reported correctly according to the code descriptions.

Affected Codes

17312-Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (e.g., hematoxylin and eosin, toluidine blue), head, neck, hands, feet, genitalia, or any location with surgery directly involving muscle, cartilage, bone, tendon, major nerves, or vessels; each additional stage after the first stage, up to 5 tissue blocks (list separately in addition to code for primary procedure).                                                                                   

17314-Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (e.g., hematoxylin and eosin, toluidine blue), of the trunk, arms, or legs; each additional stage after the first stage, up to 5 tissue blocks (list separately in addition to code for primary procedure).

Applicable Policy References

Social Security Act (SSA), Title XVIII-Health Insurance for the Aged and Disabled, Section 1862(a)(1)(A)-Exclusions from Coverage and Medicare as a Secondary Payer
Social Security Act (SSA), Title XVIII-Health Insurance for the Aged and Disabled, Section 1833(e)-Payment of Benefits
42 CFR, Section 405.980-Reopening of Initial Determinations, Redeterminations, Reconsiderations, Decisions, and Reviews, (b)-Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Initiated by a Contractor;  and (c)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Requested by a Party
42 CFR, Section 405.986-Good Cause for Reopening
CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 3, Verifying Potential Errors and Taking Corrective Actions §3.6.2.4 Coding Determinations
AHA Coding Clinic for HCPCS, Third Quarter 2013, Volume 13, Number 3, Page 1 Reporting MOHS micrographic surgery (MMS)
CPT Assistant, October 2014, Volume 24, Issue 10, Page 14, Frequently Asked Questions, Mohs Surgery, Tissue Block
CPT Assistant, November 2006, Volume 16, Issue 11, Pages 1-7, Mohs Micrographic Surgery