Billing and Coding: Mohs Micrographic Surgery (MMS)

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Mohs Micrographic Surgery (MMS) L33436. To allow separate payment for a biopsy and pathology on the same day as MMS, the 59 modifier is appropriate. Modifier 59 is also appropriate when a separate skin lesion, other than the lesion for which Mohs surgery is performed, is biopsied on the same day that the Mohs surgery is performed. If the 59 modifier is used with a skin biopsy/pathology code on the same day the MMS was performed, physician documentation should clearly indicate: That the biopsy was performed on a lesion other than the lesion on which the MMS was performed; That if the biopsy is of the same lesion on which the MMS was performed, a biopsy of that lesion had not been done within the previous 60 days; or If a recent (within 60 days) biopsy of the same lesion that MMS was performed or had been done, the results of that biopsy were unobtainable by the Mohs surgeon using reasonable effort. At this time, all laboratory tests covered under CLIA are edited at the CLIA certificate level. The previously mentioned Mohs micrographic surgery HCPCS codes would require either a CLIA certificate of registration (certificate type code 9), a CLIA certificate of compliance (certificate type code 1), or a CLIA certificate of accreditation (certificate type code 3). A facility without a valid current CLIA certificate, with a current CLIA certificate of waiver (certificate type code 2), or with a current CLIA certificate for provider-performed microscopy procedures (certificate type code 4) must not be permitted to bill for these tests.