Attn: Susan Ward re: audio conference

emeskina

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I am seeking a source for a statement made during your audio conference 'The Confident Coder: How to Code Accurately for professional services in Plastic Surgery'. During your presentation of slide 12 you made to statement that lesion size could not be coded from a path report, only from the surgeon's dictation. That goes against what I have always been told. If I am to make this declaration to my physicians and supervisor I need a specific source to site. Can you provide me with one?

Thank you in advance,
Erin Eskina, CPC
Truman Medical Center
KC MO
 
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Modesto, CA; Central Valley Chapter
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I did not attend the workshop but if you read in your CPT book under the guidelines of excision - benign lesions it specifically states:
Code selection is determined by measuring the greatest clinical diameter of the apparent lesion plus that margin required for complete excision.........a few lines later: The measurement of the lesion plus margin is made prior to excision.

This same wording is in the excision - malignant lesions as well.
 

emeskina

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That's a good point, however it still goes against the directions that I have been given stating that, in the abscence of a size recorded in the op note, you can default to the measurment given in the path report provided the dr. dictates they actually excised the lesion. In light of those directions, I would just like something more definitive to back up the statement she made. But thank you for chiming in!
 
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In absence of dictated size

Yes, we have surgeons who fail to dictate the size of the lesion, and we default to the SMALLEST size lesion.

The problem with using the pathology report is ...
1) the tissue SHRINKS after it is excised, so the pathology measurement is likely smaller than the pre-excision measurement.
2) the measurement is supposed to be the widest diameter of the lesion, plus MINIMAL margin necessary for excision. And it's possible that the actual margin was larger than the minimally necessary one.

I routinely go back to my surgeons and ask them for an addendum specifying the size. Once I explained that they are leaving money on the table by not giving us this information, they began to routinely include it in their op notes.

F Tessa Bartels, CPC, CEMC
 

emeskina

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Yes, I've tried that tactic as well; ad nauseum. It's like hitting my head against a brick wall, especially since I'm dealing with residents in training. They just seem to respond better to "official" sources. Sounds like I'm just going to have to stick with the status quo. Thanks a bunch for your input.

Erin
 
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Residents

I hear you ... I"m in a teaching hospital. BUT ... it is ultimately the teaching physician's (i.e. billing provider) responsibility to ensure that the dictation is accurate BEFORE signing it.

I've worked with these surgeons for several years, and they weren't fresh out of school when I came aboard. I still see size of lesion missing from dictations. (Or they give me the size of the lesion but not the size of the final wound that requires the layered repair.)

I just chant ... job security, job security, job security.

F Tessa Bartels, CPC, CEMC
 
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