Medical Billing Coding - 2007 MOH'S SURGERY, cpt, codes
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Thread Topic: 2007 MOH'S SURGERY
Topic Originator: ROBERTA
Post Date February 16, 2007 @ 2:17 PM
2007 MOH'S SURGERY


ROBERTA
February 16, 2007 @ 2:17 PM Reply  |  Email Friend   |  |Print  |  Top

MY INSTRUCTOR CAN'T SEEM TO FIGURE OUT HOW TO CODE THE STAGES OF MOHS SURGERY, SINCE THEY REMOVED SOME OF THE CODES THAT LISTED THE STAGES, AS WE WILL BE LEARNING THIS NEXT WEEK SHE ASKED ME TO FIND SOME INFORMATION ON CPT CODING GUIDELINES FOR THE STAGES OF MOHS SURGERY.

THANK YOU
ROBERTA

deb
February 22, 2007 @ 7:17 AM Reply  |  Email Friend   |  |Print  |  Top

Maybe you need a different "instructor"? Why is she instructing something she knows nothing about?

Steve Verno
February 22, 2007 @ 7:50 AM Reply  |  Email Friend   |  |Print  |  Top

Simple,

They hire people who don't know our profession.  It seems the qualification to teach medical coding and/or medical billing is an associates degree.  They don't care if you know the subject matter or not.

I recently applied for a medical coding and billing teaching position in Sarasota, Florida.  I was turned down because they said I was overqualified for the teaching position.   They said they want someone with less training and less experience.

So, what you get are students who pay good money and get substandard training because the instructor is substandard.

Steve Verno
February 22, 2007 @ 7:55 AM Reply  |  Email Friend   |  |Print  |  Top

Roberta,

It is not your job to do research for the instructor.  That is her job.  That is what YOU are paying her to do for you.

If my instructor asked me to do research because of coding changes and because the instructor doesn't know the subject matter, I would be getting my money back and filing a complaint with the FTC and the State Board of Education.

Leah
February 22, 2007 @ 8:16 PM Reply  |  Email Friend   |  |Print  |  Top

"It seems the qualification to teach medical coding and/or medical billing is an associates degree.  They don't care if you know the subject matter or not."

Yep, despite the fact that there are virtually NO degrees offered by any college or university for billing and coding - only "certificates".  A certificate granted by such prestigious institutions as AAPC, AHIMA, MAB and AMBA are not sufficient to secure even a part-time job teaching billing and coding.  I know, I've tried many times.

Barb S.
February 23, 2007 @ 10:21 AM Reply  |  Email Friend   |  |Print  |  Top

Roberta,

I'm certified in Mutispecialty (CPC) and Dermatology (CDC) and will be glad to help you. I've taught coding and agree with many of the others that many "schools" set up classes for Coding without any idea of what it involves. However, agreeing with that doesn't help you, and the other students (who may or may not be able to get your money back and). You're trying to learn.

Mohs: The old codes 17304 -17310 described the unit of service as the number of sepcimens. The new codes 17311-17315 describe the unit of service as blocks, rather than specimens. A "tissue block" is tissue embedded in a mounting medium for sectioning. So the new codes better reflect the work involved. ("blocks" performed in lab by surgeon or histotech)

A "stage" involves the removal of one layer of tissue. Each stage may be divided into blocks. (pt. in surgical suite)  

Do not confuse"stages" removed with the "blocks" made in the lab.

Also remember that the pathology codes are not reported separately on the same specimen as part of Mohs surgery.

Code 17311: First stage code for head, neck, hands, feet, genitalia, any location with surgery involving muscle, catilage, bone, tendon, major nerves, or vessels.

Code 17312: Second and subsequent stage code for hed, neck, hands, feet, genitalia, any location with surgery involving muscle, cartilage, bone, tendon, major nerves or vessels.

Code 17313: First stage code for trunk, arms and legs.

Code17314: Second and subsequent stage code for trunk, arms, legs.

Code 17315: Additional blocks beyond the first 5 on a given stage. Billed once per additional tissue block.

A first stage code (17311 or 17313) is reported only one time for each lesion treated by Mohs surgery at that treatment session.
(two lesions treated = 17311 x 2 or 17313 x 2 or 17311 x 1 & 17313 x1) depending on location of lesions)

Code 17315: Used for every additional block beyond 5 when excised specimen is cut into more than 5 blocks for processing.
Each block beyond the 5th on a given stage is billed with one unit of 17315.
   Example: Lesion on trunk with 6 blocks on the first stage (1st layer), 8 blocks on the second stage (layer), 4 blocks on the third stage (layer), and 5 blocks on the 4th stage (layer) :
   1st stage: 17313, 17315 x 1
   2nd stage: 17314, 17315 x3
   3rd stage: 17314
   4th stage: 17314
You would code: 17313 x 1, 17314 x3, 17315 x4  

Another example for Mohs: Patient has two lesions on his hands treated. 1st lesion, one stage. 2nd lesion 2 stages.
You'd code 17311, 17311-76, 17312.   (Some insurance carriers may prefer the -59 modifier rather than the -76 modifier. -76 is more specific.)

Barb S.
February 23, 2007 @ 10:21 AM Reply  |  Email Friend   |  |Print  |  Top

Roberta,

I'm certified in Mutispecialty (CPC) and Dermatology (CDC) and will be glad to help you. I've taught coding and agree with many of the others that many "schools" set up classes for Coding without any idea of what it involves. However, agreeing with that doesn't help you, and the other students (who may or may not be able to get your money back and). You're trying to learn.

Mohs: The old codes 17304 -17310 described the unit of service as the number of sepcimens. The new codes 17311-17315 describe the unit of service as blocks, rather than specimens. A "tissue block" is tissue embedded in a mounting medium for sectioning. So the new codes better reflect the work involved. ("blocks" performed in lab by surgeon or histotech)

A "stage" involves the removal of one layer of tissue. Each stage may be divided into blocks. (pt. in surgical suite)  

Do not confuse"stages" removed with the "blocks" made in the lab.

Also remember that the pathology codes are not reported separately on the same specimen as part of Mohs surgery.

Code 17311: First stage code for head, neck, hands, feet, genitalia, any location with surgery involving muscle, catilage, bone, tendon, major nerves, or vessels.

Code 17312: Second and subsequent stage code for hed, neck, hands, feet, genitalia, any location with surgery involving muscle, cartilage, bone, tendon, major nerves or vessels.

Code 17313: First stage code for trunk, arms and legs.

Code17314: Second and subsequent stage code for trunk, arms, legs.

Code 17315: Additional blocks beyond the first 5 on a given stage. Billed once per additional tissue block.

A first stage code (17311 or 17313) is reported only one time for each lesion treated by Mohs surgery at that treatment session.
(two lesions treated = 17311 x 2 or 17313 x 2 or 17311 x 1 & 17313 x1) depending on location of lesions)

Code 17315: Used for every additional block beyond 5 when excised specimen is cut into more than 5 blocks for processing.
Each block beyond the 5th on a given stage is billed with one unit of 17315.
   Example: Lesion on trunk with 6 blocks on the first stage (1st layer), 8 blocks on the second stage (layer), 4 blocks on the third stage (layer), and 5 blocks on the 4th stage (layer) :
   1st stage: 17313, 17315 x 1
   2nd stage: 17314, 17315 x3
   3rd stage: 17314
   4th stage: 17314
You would code: 17313 x 1, 17314 x3, 17315 x4  

Another example for Mohs: Patient has two lesions on his hands treated. 1st lesion, one stage. 2nd lesion 2 stages.
You'd code 17311, 17311-76, 17312.   (Some insurance carriers may prefer the -59 modifier rather than the -76 modifier. -76 is more specific.)

Steve Verno
February 23, 2007 @ 10:56 AM Reply  |  Email Friend   |  |Print  |  Top

Barb,

Excellent response, and I could have provided the same answer but I didn't want to because of the following:

1)  yes, we are all here to help and to provide answers to the questions posted, but, I feel we must draw the line when it comes to a student in a class and my reason is as follows:

a.  The student is paying the institution to learn about our profession.

b. The instructor is paid by the institution to teach the subject matter.

c.  The institution AND the instructor have an obligation to present the subject matter with any changes that occur.

By having the student research the changes for an upcoming class is completely WRONG!  (Caps for for emphasis only)

This institution should have identified the changes and corrected the cirriculum without having to involve the student.  

I am seeing too many students coming to these forums because of substandard training and instructors who do not know the subject matter.  We are not here to take the place of the instructor.  We are here to help the medical coder or medical biller once they complete their training.  By helping the student, we are simply exacerbating the problem with a substandard institution with substandard instructors.  If I were a student and my instrctor came to me and said that we are going to teach MOH next week but I don't know all the changes that were made to MOH, would you research the changes for me, I would be insulted.  To me, I would ask, what else doesn't this instructor know and what has already been presented to me, is this correct and accurate?  

I am not here to demean any postings of help at all, but we need to draw the line when it comes to students.  On another forum, a student came and actually asked for help on several topics.  What we found out is that the student posted the test questions for their on line class and wanted us, the experts, to take the test for them.  Once we stopped, this person never came back again.  One student was so brazen that they said, "This is a question on my final test, can someone help me with the answer."  

The Federal Trade Commission receives so many complaints about substandard training and they are investigating these institutions.  The students come out not really prepared for the reality of what we do.  I and others are seeing the damage these undertrained students are doing once they go to work for a doctor.  

On a personal note, I was recently turned down for an instructor position because I was "overqualified".  They asked me to find someone with less education and teaching experience.  This is why these students have a problem.  

Now, you may have a different point of view on this matter and I respect that, but if we continue to do the instructor's job, how can the student and future students receive the proper training they paid to receive?

Cynthia Newby, CPC
February 23, 2007 @ 11:02 AM Reply  |  Email Friend   |  |Print  |  Top

In a more helpful vein-- get a copy of the CPT CHANGES 2007: An Insider's view. This book comes out from the AMA every year around Thanksgiving and covers all the CPT new codes.
I also have some materials from the AMA's CPT symposium I attend midNov -- specifically re MOHS. If you want to send me your mailing address, I can send you a copy of those pages from my course book

Barb S.
February 23, 2007 @ 11:51 AM Reply  |  Email Friend   |  |Print  |  Top

Steve,

I understand your viewpoint. I also understand the students fustration and viewpoint.
Unfortunatly I at one time signed a contract to teach coding. I then discovered that the school did not have any idea of what medical coding involved. The instructors had problems getting the materials we needed (i.e. correct up-to-date books) I did the best I could for the students while I was there. Also got out of the contract before second semester..
Many of the students later contacted me and asked my help as they were working to get their money back. It took over two years to work through the legal system for their refunds. Some of the students were in "learning programs" provided by state or county funds and had to stick with the program. It was very hard on them and fustrating to say the least. The instructor hired to replace me the second semester was not qualifed.

It's because of the above, that I provided information this one time. Like you, I do not plan on making it a regular activity.

Thank you for your input. I feel it's important that people are aware to check out a school or program they are planning to attend. Many are not aware they can contact their area's AHIMA or AAPC chapters to get information on accredited classes. This type of forum helps.

Steve Verno
February 23, 2007 @ 12:19 PM Reply  |  Email Friend   |  |Print  |  Top

I agree Barb, having been involved in teaching for the past 35 years.

I do feel for the student but sometimes we need to have tuff love to get the message across.

One thought that came to me, what if, and I say this with a big IF, what if this student was assigned to present MOH changes as part of their homework assignment?  By giving them the answer, they don't need to do the homework.  They can copy, paste and present your hard work as theirs. I know because this happened to me recently, where someone took my posting and presented it as their work,  Unfortunately for the student, the instructor knows me and recognized my posting.  The student, even when presented with the proof of plaigerism, still stated they created the work.

Barb S.
February 23, 2007 @ 12:25 PM Reply  |  Email Friend   |  |Print  |  Top

Steve,

Good points. I may be too trusting taking a student at "their word". I'll keep that in mind.

Curt
May 5, 2008 @ 11:53 AM Reply  |  Email Friend   |  |Print  |  Top

The "Tissue block" is a term which the coding book moved to in 2007.  Does Tissue Block, in the instance of Mohs surgery, mean the same as lesion?  In other words, the patient presents with 4 separate basal cell lesions - 2 on forehead, 1 arm, 1 trunk.  Are these the same as 4 Tissue Blocks?

Nancy
July 20, 2010 @ 4:15 PM Reply  |  Email Friend   |  |Print  |  Top

I totally agree Steve.



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