Results suggested "impressive adherence" to updated clinical guidelines.

Complex repairs billed by Mohs surgeons decreased significantly from 2019 to 2021 in the wake of new coding guidelines, according to a national Medicare analysis.

Publishing in Dermatologic Surgery, Christian Gronbeck, MD, of the University of Connecticut, Farmington, and colleagues compared the volume of intermediate and complex skin repairs performed by Mohs micrographic surgeons before and after the 2020 guidelines. The study included 2,764 Mohs micrographic surgeons (MMSs) who performed a total of 629,532 intermediate and complex repairs in 2021.

Over the study period, the proportion of complex repairs performed by MMSs decreased from 63.2% to 75.2% (P < 0.0001). The updated coding provided more differentiation guidance between complex and intermediate repairs on the degree of undermining, the exposure of named subcutaneous structures, and the involvement of free margins. Complex repair coding decreased across all subgroups of MMSs, but the greatest decreases were among surgeons in academic settings (-22.6%), followed by those with Micrographic Dermatologic Surgery certification, members of the American College of Mohs Surgery, and surgeons with less than 15 years of experience.

“Given that MMSs perform a higher volume and proportion of complex repairs as compared with other physicians, the demonstrated shift among these individuals is particularly impactful in reducing overall complex repair utilization in the Medicare population,” the researchers wrote in the study.

The findings were limited by the exclusion of surgeons with low volume of procedures and lack of data on patient factors that might affect choice of repair. However, the results highlighted the “impressive adherence” to the updated guidelines by MMSs and the importance of raising awareness of appropriate billing, the researchers concluded.

Source: Gronbeck C et al. Sustained Shift Toward Intermediate Repairs by Mohs Surgeons Following Updated 2020 Coding Guidelines: A National Medicare Analysis. Dermatologic Surgery. March 22, 2024. DOI: 10.1097/DSS.0000000000004176