Pathology/Lab Coding Alert

Don't let 238/239 confusion leave medical necessity to chance. You may feel "uncertain" when selecting a neoplasm code for a pathology report -- but that doesn't mean the lesion is uncertain. Mistaking "uncertain" for "unspecified" could cost you, based on payers' covered diagnosis lists that impact medical necessity decisions. Take a look at our experts' explanations and examples to make sure you know the difference. Know the Big Picture To understand the uncertain/unspecified distinction, you need to comprehend the overall neoplasm diagnostic classification scheme. The ICD-9 neoplasm table distinguishes cancers as malignant, benign, uncertain, or unspecified. Let's start with the malignant/benign difference, because that's the key to understanding the "uncertain" classification. "Malignant neoplasms are cancerous, and may be noninvasive (in situ), or invasive," explains R.M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark. ICD-9 further subdivides invasive cancers as "primary," meaning that the cancer arises from surrounding [...]