Dx Code

[mchristner]

Good Morning!!! I am trying to find what ICD 9 code I would use to code a suspicious skin lesion. I see 709.9 for skin lesion, but is there anyway to show it was suspicious? Some of the insurances do not pay for mole removals, etc. because they say it is cosmetic. Does anyone know a dx code that would be more specific than skin lesion 709.9? How can we differentiate the ones removed for medical reasons rather than cosmetic?

[mitchellde]

If this is an excision then you must wait for path before sending the claim, then if the path is benign you may use V71.1 for observtion and evaluation of suspected malignant neoplasm not found. This is first listed only. If there is no excision the 709.9 or 709.8 is the best it gets.

[CHEINRICH]

You can also look at the neoplasm table in your tabular list....there are columns for unspecified and uncertain behavior of lesions....It might also be good idea to educate physician to word his documentation as uncertain behavior when he is not definitive about a lesion versus just saying suspicious although it should be ok otherwise, however, it is always safer to educate physicians on using proper wording in their documentation as to avoid any problems

[FTessaBartels]

Originally Posted by CHEINRICH

You can also look at the neoplasm table in your tabular list....there are columns for unspecified and uncertain behavior of lesions....It might also be good idea to educate physician to word his documentation as uncertain behavior when he is not definitive about a lesion versus just saying suspicious although it should be ok otherwise, however, it is always safer to educate physicians on using proper wording in their documentation as to avoid any problems

"Uncertain behavior" is a specific diagnosis provided by the PATHOLOGIST after examining the specimen. It is NOT appropriate for the physician removing the lesion to dictate this in order to use that series of codes.

F Tessa Bartels, CPC, CEMC

[mitchellde]

Absolutely correct Tessa. The key word is "BEHAVIOR" this denotes uncertain behvior on the part of the cells which you cannot know without pathology. This is the coder assigning a dx not documented by the physician. This dx can have very harmful effects on the patient in the long run with respect to coverage and benefits. Thanks Tessa for helping me educate on this issue this is one of my soap boxes!