What are the primary billing rules for dermatology and Mohs surgery in Texas?
Dermatology practices in Texas are subject to Local Coverage Determinations (LCDs) enforced by Medicare contractor Novitas Solutions (Jurisdiction H), as well as commercial payer policies from BCBSTX. Mohs micrographic surgery (CPT 17311-17315) requires strict documentation that the surgeon acted as both surgeon and pathologist, detailing anatomical site, histologic margins, and staging. Biopsies (CPT 11102-11107) performed on the same day as a full-body examination require modifier -25 on the E/M code only when clear medical decision-making beyond normal pre-procedure assessment is documented. Routine removal of benign skin lesions (seborrheic keratoses, skin tags) is deemed cosmetic by Novitas unless specific symptoms (bleeding, obstruction, pain) are clearly recorded.
1. The High-Volume Sunbelt Dermatology Environment
With over 230 sunny days per year and an outdoor lifestyle, Texas has one of the highest skin cancer incidence rates in the nation.
Dermatology practices in Austin, Dallas, and Houston handle massive volumes of actinic keratoses (CPT 17000/17003), basal cell carcinomas, squamous cell carcinomas, and malignant melanomas.
2. Mastering Mohs Micrographic Surgery Coding
CPT 17311 through 17315 anatomical site groupings
Mohs surgery is divided by anatomical location:
• Head, neck, hands, feet, genitalia (CPT 17311 first stage, 17312 additional stages).
• Trunk, arms, legs (CPT 17313 first stage, 17314 additional stages).
Repairs (intermediate 12031-12057, complex 13100-13153, or adjacent tissue transfer 14000-14061) are separately billable but must be clearly documented with surgical defect measurements.