Medicare Compliance & Reimbursement

Pathology report can unlock $57 more for 11620 if it justifies using the malignancy code. If recent guidance made you question the MO of waiting for the path report, rest assured you can continue to delay assigning the benign or malignant lesion removal until you have the definitive diagnosis. A new local coverage determination (LCD) related article "indicated that providers are to bill lesion removals based on what is known at the time of excision, regardless of what the pathology report shows," points out Heather Winters, CPC, at United Cerebral Palsy Association of the North Country in Malone, N.Y. Now that your eyebrows are raised, here's the scoop. Prevent Mislabeling by Waiting for Definitive Diagnosis Traditionally, experts have recommended waiting for the path report before assigning a benign (11400-11446) or malignant lesion excision code (11600-11646). "You don't want to call a lesion malignant unless the pathology report does," says Jill [...]