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  #11  
Old 08-07-2010, 08:37 PM
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mitchellde mitchellde is offline
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Quote:
Originally Posted by ambernewcomb View Post
If the Dr is coding the procedure as a biopsy (11100) then you would not know what the diagnosis was and you would use 238.2 as your diagnosis code.

If you are coding it with the excision codes 11400 - 11406 then you would use the 216.5 diagnosis code.

If it turns out to be malignant then you would use the excision codes 11600-11606 and the diagnosis code would be 173.5 for Basal cell carcinoma and Squamous cell carcinoma, and 172.5 for Melanoma, if it is malignant in situ then the diagnosis would be 232.5

You don't code the excision codes until you have the diagnosis, they will not pay for the unknown diagnosis code 238.2.

Often my dermatologists will code the biopsy code for the original surgery and then when they do the reexcision to remove the rest of the lesion they will code with the excision codes and by then we already know the diagnosis code and do not have to hold the claim while we wait for path.

Hope this helps,

Amber L. Newcomb
CPC
Dermatology
Again 238.x codes are not to be used until you have a path report that states uncertain behavior. The dx code is not for uncertain as to morphology, they are for uncertain BEHAVIOR morphology. You do not use this dx code for a biopsy, unless you have waited for the path and that is the result, you can use a 709.x code for the biopsy. If your physician does a full thickness removal of the entire visible lesion then it is not a biopsy it is an excision. If path shows positive margins then you may code for the re-excision when the physician performs that and you do already have the path report.
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Old 08-17-2010, 05:26 PM
muthershyp muthershyp is offline
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When coding an excision, always wait for the pathology report otherwise how would you know whether to use a benign excision code or a malignant excision code.

283.2 falls into a catagory of neoplasms which have already been microscopically reviewed and are still uncertain.
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  #13  
Old 08-17-2010, 11:19 PM
preserene preserene is offline
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I agree with Mitchellede in her saying "The dx code is not for uncertain as to morphology, they are for uncertain BEHAVIOR with its morphology". Even there are many schools of thoughts and controversies about its behavior between Clinicians and Pathologist.
I would like to state that
morphology does not always predict biological behavior any more than a biopsy
will always give a diagnosis.
In my openion, the clinician is obliged to re-excise, and explain to the patient that
microscopically it has features that appears to be "pre-malignant or starting
to become malignant" and that the site should be re-excised for maximum
safety.

There are degrees of
"benign", i.e. mild-to moderate-to-severe cytologic atypia, and that we
should re-excise moderate to severe atypia with adequate margins. Its clear from this discussion that all this stuff
about mild, moderate, and severe cellular atypia and mild, moderate,
severe architectural atypia doesn't
amount to anything except to detract from communication of whether
something is benign, malignant, or "unsure". The responses as to what all of us are doing re: "nevi w/ architectural
disorder and 1)mild 2)moderate 3) severe melanocytice atypia has been
interesting, but since this is a relatively new categorization of nevi.
Are there "benign"melanomas, an addition to the spectrum of benign PL, dysplastic PL, MIS,
SSM, nodular MM, Met. MM? I do not know any answers to these issues but
they are certainly very important questions. It is unclear if future molecular diagnostics will help or obfuscate the answers.
As for us for our discussion, the "dysplasia' is a condition just a step away of the carsinoma in situ and its biological behavior is unpredictable .This is the bottom line of the interpretation of the all these terminology and let us leave the debate to doctors with unbiosed openion about its future behavior which is not in our hands especially unpredictable types of this dysplastic nature

Last edited by preserene; 08-17-2010 at 11:21 PM.
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  #14  
Old 07-25-2011, 01:43 PM
mfloit mfloit is offline
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239.2 can be a better code to use if you are billing for the biopsy prior to the pathology.
When its an excision, always wait for the pathology before billing.

In response to the comment of rule out codes...you can code a "rule out" diagnosis ONLY in an INPATIENT SETTING.
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Old 07-25-2011, 05:57 PM
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Quote:
Originally Posted by mfloit View Post
239.2 can be a better code to use if you are billing for the biopsy prior to the pathology.
When its an excision, always wait for the pathology before billing.

In response to the comment of rule out codes...you can code a "rule out" diagnosis ONLY in an INPATIENT SETTING.
Only if you are the inpatient facility coder not the physician coder.
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Old 03-08-2013, 12:18 PM
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valleycoder valleycoder is offline
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i realize that this is an old post but when i see or hear a statment like "insurance wont pay for xxx.xx dx so we use xxx.xx", the compliance auditor in me is immediately activated and i cannot let this slip by without saying that if you are following that theory, you are putting the organization that you work for at a huge liability risk should you ever get audited. You should never code to get something paid - you code the service as it is.

Secondly, i'm not really sure why anyone is contemplating the use of 238.x. If you look up nevus in the tabular, it distinctly says neoplasm/skin/benign, which doesnt crosswalk to 238.x

And lastly, i want to echo Debra's response regarding coding a rule out for inpatient facility coders only. Just because a patient is inpatient doesnt mean you can code rule outs for professional fees.

i hope some of the comments in this posting are simple misspeaks.
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Old 02-27-2014, 01:30 PM
KaitlynEFitch KaitlynEFitch is offline
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You don't code the biopsy (11100) as a 238.2... you would wait for the biopsy results to come back and use the definitive diagnosis for everything that is ever sent off to a lab.
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