How to Document Mohs Procedure

How does a patient show up in the Mohs Module? 

When a treatment plan with the plan type "Mohs" is added into an encounter that patient will appear in the Mohs Module. The Mohs module only shows patients who are scheduled for Mohs today. 

This can be done 2 ways:

• From the Pending Review folder > choose Mohs treatment plan for the plan > schedule the appointment as a follow-up linking to this diagnosis. You can tell if a problem has a plan attached to it by an "i" icon to the right of the diagnosis. Go to the Mohs module > the patient will appear under the "Planned" tab > tap Execute to begin documenting. 

• From the physical exam >  tap "New" > "Assessment & Plan" > Choose a Mohs treatment plan > tap on the location on the 3D body map > go to Mohs module and you will see the patient under the "In Progress" tab.

Documenting the Mohs procedure

Removal

1. After selecting Execute, the patient will be moved to the In Progress tab and you will be brought into the documentation screen for the first stage of your Mohs procedure. All documentation is done on a per-stage level, including the repair as well. From here you will be able to see the diagnosis and location, as well as add a Mohs case number and change the status of the procedure if needed. 
2. Enter in the Initial Dimensions of the defect and that value entered will automatically be set as your Pre-operative Dimensions. For any additional stages, the Preoperative Dimensions will be pulled forward from what was entered in the Postoperative Dimensions of the previous stage. Note that the Initial Dimension field will pull through from the first appointment if they were entered at that time. 
3. The fields for Preoperative and Postoperative images allow you to either take a photo with your iPad or select a photo from your photo library. The Postoperative Image field is also where you will be able to draw your Mohs diagram. To do so, tap on the picture in that field, tap edit in the upper right-hand side of the screen, and select the option Create Mohs Diagram.
4. From here you will be able to either use the original image or crop it to your liking, and then you will see that the system has auto-generated some text for you, which you can edit via tapping into the box and free-typing. Draw your Mohs diagram from this screen by using the tools at the bottom. 
5. The Morphology and Narrative Note pull directly from the treatment plan settings but you do have the ability to change this text by tapping into each field. 
6. The Procedure Summary segments are where you have the ability to enter details specific to the procedure such as anesthesia used, surgical scrub, and any other segments that were selected within the settings of the treatment plan.
7. Two important procedure segments to take note of here are Mohs Sections and Postoperative Dimensions:

MOHS SECTIONS

• This is where you indicate to the system that you want to have additional stages for this Mohs procedure. 
• If the number in the Positive column is anything other than zero, the system will generate another Mohs stage. 

POSTOPERATIVE DIMENSIONS

• Whatever is entered in this field will be pulled through as the Preoperative Dimensions of the subsequent stage, if there is one.
• If there is not a subsequent stage, the value entered here will help calculate the correct size-specific repair code. 

The Reviewed toggle at the bottom of the screen marks the stage as reviewed with a small 'R' icon when looking at the module screen and is intended to strictly be a visual aid to help you keep track of the progress of the procedure. 

Repair

1. Once you have no positive Mohs sections remaining, you can begin documenting on the repair. You will do so by tapping on Execute on the Repair section next to the last stage. This will pull up a list of all of your treatment plans that have a plan type or Repair, and from here you can select the repair plan you would like to use by tapping on it. 
2. As stated above, the Preoperative Dimensions for the repair will be whatever was set as the Postoperative Dimensions for the final stage. 
3. Documentation for the repair is very similar to the Mohs stages, but the Procedure Summary segments will be unique for the repair. Again, these are pulling from the settings of the selected treatment plan. 
4. Be sure to include Postoperative dimensions for your repair, as the system uses this field for coding. 

Wrapping Up

• Once all of your documentation is complete for the patient, you can move them to the Completed tab within the Mohs module by tapping on the share button in the top right and selecting Completed. Additionally, from the share button, you can also access the Procedure Notes. 
• The note still needs to be signed off on, so you can tap on the patient's name to be taken into their chart and then select the day's encounter to be taken into the progress note. Don't forget to look at the coding screen to verify that all of that information is correct, and sign off on the note when complete. 
• The patient will be removed from the Mohs module when their progress note is signed. 
• For information on how to generate a Mohs referral letter, please see this article.