What to Do about the Multiple Surgery Reduction?
All dermatologists have been affected by this change unless you are strictly a cosmetic derm, and now you are probably facing a host of other issues. There is no quick fix to get around this reduction rule, it has affected all dermatologists and will continue to as long as you are doing skin cancer surgeries. Before 2008, if the Mohs surgeon did both the Mohs and the repair procedure, both codes were paid at 100 percent, because Mohs was exempt from the Multiple Surgery Reduction Rule. Prior to 2008, the reimbursement would have been $1,139. Now, the complex repair would be reimbursed at $256, for a total reimbursement of $872, or $267 less than before.
If the wound is closed with an adjacent tissue transfer code — 14060 — the national average reimbursement is $696.
So, the reimbursement prior to 2008 would have been 100 percent for both procedures — $616 for the Mohs and $696 for the repair for a total of $1,312; now, the reimbursement would be 100 percent for the repair, or $696, and $308 for the Mohs, for a total of $1,004 ($308 less than before).
Most dermatologic surgeons who did not perform Mohs surgery, have been performing procedures that were not exempt, such as excisions and repairs for years. Dermatology billers and coders have really had to stay up on all of the changes, with new CPT rules this past year and the Mohs reduction rule, it was not a good year for dermatology medical practices. In most states, Mohs is the bread and butter and with Mohs reduction rule and multiple surgery reduction, surgeons have to start thinking about their bottom line and how their decisions are affecting it.
Two Surgeons Performing Mohs
Add on surgeries should be a thing of the past unless absolutely necessary. Patient care should not be sacrificed to gain 100% reimbursement, but there are ethical and safe ways to maximize reimbursement. A lot of physicians and coding experts will tell you that having multiple physicians do different parts of the surgery is an unethical way of doing it. I disagree. In my old practice we had a Mohs Surgeon and Plastic Surgeon and even before this ruling would have the Plastic Surgeon close some of the surgeries on the face or when a large flap/graft was needed. This was done to give the patient the best possible outcome. I fell that this an appropriate measure for Mohs surgeons to take if they have someone else in their practice that is more or equally proficient in closures. The training at all mohs programs is different and some physicians may have more experience in facial repairs, cartilage transfers, nose repairs, tissue transfers, and other more complex repairs.
NP or PA Assisted Surgery Increase your Volume
Another way to positively affect your bottom line considering the cuts in Mohs and surgery is to have assistance. You cannot work yourself to death and see the same returns. Now, you work yourself to death and find that your reimbursements are cut by an average of 25%. Instead of working harder, work smarter. How many times have you heard that one? Well, with regards to surgery, you have to work smarter if you want to maintain your lifestyle and continue to do well financially. Utilizing your Physician Assistant or Nurse Practitioner is a great way to improve your efficiency and productivity. Assistance with top layer sutures and minor excisions with simple-intermediate repairs can make your operating time more productive by allowing you to focus on the larger repairs and Mohs.
Incident To Billing
Instead of billing incident to, you can also use an experienced NP or PA to perform the exision and bill under there own number. This would mean that you will only receive 85% of the actual reimbursement but for excision, you don’t get paid anything by doing it all yourself. Obviously, you do not want to do anything unethical or be coding with gross circumvention of the multiple reduction rule. Use common sense and keep patient care in mind when making your financial decisions.
No Same Day or Multiple Site Surgeries
Stay away from doing multiple locations on the same patient or by doing multiple mohs on the same date of service unless necessary because of patient care.
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Comments
I am considering starting MOHS surgury in my practice but this multiple exeption rule reversal has me concern. The use of another physician at one’s office or a physician extender that are in your practice that probably are being billed with the company’s group practice # first and then one will use the providers# second; Can you get 100% reimbursement using the second person to do the closure? Or because it’s the same group # then would it be denied? Can you please answer me back with my email. Thank you.
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