Closure Following Mohs Surgery

Question:

If a patient is referred to a plastic surgeon after a Mohs surgeon performs a Mohs procedure, to perform a complex repair, do I need to add a modifier to the plastic surgeon's repair code?

Answer:

Thank you for your question. You do not need a modifier on the plastic surgeon’s repair code when the Mohs surgeon and the repairing surgeon are different specialties.

When two different physicians perform services on the same day, Medicare and most commercial payers treat them as separate providers, each with their own global surgical package. Because of that:

• The Mohs surgeon bills the Mohs codes (17311–17315).

• The plastic surgeon bills the appropriate repair code (simple, intermediate, complex, flap, graft, etc.).

• No modifier (e.g., -58, -59, -79) is required because there is no global period conflict between two different physicians.

This is consistent with standard Mohs billing guidance, which states that repairs performed by a different provider are billed normally and not considered part of the Mohs surgeon’s global package.

*This response is based on the best information available as of 09/03/26.

17110 for AK?

Question:

Is 17110 appropriate for using liquid nitrogen for irritated actinic keratoses?

Answer:

No — 17110 is not the correct destruction code for actinic keratoses.

Destruction of actinic keratoses should be reported as follows:

• 17000 for the first lesion

• 17003 for each additional lesion (for lesions 2–14)

• 17004 when 15 or more lesions are treated

Documentation should clearly include the method of destruction, the location of each lesion, and the total number treated.

Thank you for reaching out to KZA!

*This response is based on the best information available as of 08/06/26.

Pilonidal Disease Excision

Question:

I frequently perform adjacent tissue transfers (CPT 14000, 14001, 14020). When I excise pilonidal disease (CPT 11770, 11771, 11772) and then perform an adjacent tissue transfer, can I report both the excision and the tissue transfer codes, or is only the tissue transfer separately billable?

Additionally, in cases where I excise a malignant lesion (CPT 11604, 11606) and close the defect with an adjacent tissue transfer, my understanding is that only the adjacent tissue transfer code (e.g., 14000) is reportable, and the excision is considered included. Is this correct?

Answer:

This is a great question. Even though pilonidal excision is a “disease excision” rather than a lesion excision, CPT still treats the excision as included in the ATT. If you excise pilonidal disease and close with an adjacent tissue transfer (e.g., Limberg flap, Karydakis flap, Z-plasty), you bill only the ATT code (14000–14001–14020 etc.). Keep in mind when you perform an adjacent tissue transfer to close a defect, you do NOT separately bill the excision of a lesion (benign or malignant).

The ATT includes:

• Creating the defect (whether by trauma or excision)

• Preparing the wound bed

• Closing the defect with the flap

The excision is considered included in the ATT code.

This applies to:

• Benign lesion excision (11400 series)

• Malignant lesion excision (11600 series)

• Benign cyst excision (e.g., pilonidal disease 11770–11772)

• Scar revision excision

• Any excision that results in the defect you are closing with ATT

*This response is based on the best information available as of 07/16/26.

Biopsy of Lip

Question:

A provider performed a shave biopsy of the vermillion border using a dermablade. Would you report 11102 or 40490 for cases like this? What warrants reporting CPT Code 40490?

Answer:

Thank you for your question. For a shave biopsy of the lip skin or vermillion border performed with a dermablade, 11102 is the correct code. CPT 11102 covers tangential (shave/scoop/curette) biopsies of skin and skin appendages, which includes the cutaneous lip and vermillion. A dermablade is the classic instrument for a tangential/shave technique, which maps directly to the 11102 description. The lip, for integumentary coding purposes, is treated as a skin site when the biopsy involves the surface epithelium/vermillion using a shave technique

In order to report CPT code 40490 (biopsy of lip), the biopsy requires incisional technique into the deeper lip tissue (submucosa, muscle). The lesion is on the mucosal surface of the lip (wet mucosa, not vermillion or skin). A punch or excisional approach is used on the lip mucosa and the clinical intent is to sample submucosal pathology (e.g., suspected mucocele, minor salivary gland lesion, deeper fibrosis).

*This response is based on the best information available as of 06/04/26.

Skin Tag Removal

Question:

Is it correct to report 11300-11313 for the removal of 4 skin tags by shave?

Answer:

In this scenario, the diagnosis determines the correct code selection. For skin tags, the appropriate codes are 11200–11201. The guidelines for these codes state, “Removal by scissoring or any sharp method,” which would include “shave.” Therefore, it would not be appropriate to report codes 11300–11313 (shaving of epidermal or dermal lesions) for this service. The removal of 4 skin tags would be correctly reported with 11200.

Thank you for reaching out to KZA!

*This response is based on the best information available as of 05/07/26.

Medical Decision Making

Question:

The patient has a recurrent keloid following surgical excision and is largely asymptomatic, with only occasional pruritus and burning. Does this fall under low or moderate medical decision making?

Answer:

Based on the condition alone, a recurrent keloid that is stable and only mildly symptomatic would generally meet Low MDM under the “Number and Complexity of Problems Addressed” element. However, the final MDM level cannot be determined without considering the other two MDM elements: data reviewed and the risk of treatment and management. If no data is reviewed and management is limited to observation, conservative measures, or a minor procedure with no risks, the overall MDM would remain low.

*This response is based on the best information available as of 04/02/26.