Wiki Atypical B Cell Infiltrate diagnosis help

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We received a pathology report back and trying to confirm the correct coding for it. ATYPICAL B-CELL INFILTRATE CONSISTENT WITH CUTANEOUS DEPOSIT OF CHRONIC LYMPHOCYTIC LEUKEMIA/SMALL LYMPHOCYTIC LYMPHOMA....
C91.1 but the path doesn't state if in remission or relapse- Any suggestions or insight would be appreciated.
 
Hi RPorter,
There is not enough information from the little bit of the pathology report your provided to assist you for proper diagnosis assignment. You may not assign C91.1x based on the statement you provided because per our ICD Guidelines because that statement is deemed as an uncertain diagnosis. The guidelines in our ICD book clearly state to not code diagnoses documented as "probable", "suspected", "questionable", "rule out", "compatible with", "consistent with" or "working diagnosis" or other similar terms indicating uncertainty.
If you wanted to share a little more information on the remaining pathology report that wasn't shared; gross description - what was reviewed, or any other comments the pathologist have provided in their report along with the indication on why the specimen was sent to the pathology department for review. I would be able to help you.
Thank you for listening and have a great evening,
Dana Chock CPC, CANPC, CHONC, CPMA, CPB, RHIT
 
Hello, thank you for your response below is a snip from the path report- this is for a providers office visit and not an inpatient facility -

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Hi RPorter,
May I ask a question please? Is there a reason you would not be waiting for the consultation results to code this scenario? The pathology report states that "due to the unusual nature of this case it was sent to Laszlo J Karai, M.D., Ph.D for consultation and a copy of the consultation would be forwarded to your office for review".
Why would you want to code this in haste without Dr. Karai's consultation report?
Yes, I wholeheartedly get the coder productivity, number of days the accession is in the WQ (even deferred), and the not checking the box to bill in PowerPath but this is continuity of care.
This is in my "complete" opinion, we wait for Dr. Karai's professional opinion from the consultation request from the slides/possible block that they may have received before rendering a final diagnosis.
I usually see an addendum (or even amendment) to the original report that pulls in Dr. Karai's findings once the consultation has been completed. It is really okay to wait. Sometimes a consultation can take over 2-3 weeks so be patient and just routinely check to see if there has been any updates to complete your coding.
Thank you for listening and have a wonderful evening,
Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT
 
Dana, I greatly appreciate you taking the time to respond, the following is from the consultation report

DIAGNOSIS: A. Skin, Biopsy, left clavicular neck ATYPICAL B-CELL INFILTRATE CONSISTENT WITH CUTANEOUS DEPOSIT OF CHRONIC LYMPHOCYTIC LEUKEMIA/SMALL LYMPHOCYTIC LYMPHOMA SEE COMMENT COMMENT: PART A (left clavicular neck): THE SUBMITTED CLINICAL IMAGE WAS CONCURRENTLY REVIEWED. CLINICAL, ONCOLOGIC CORRELATION IS RECOMMENDED.
 
Hi RPorter,
Oh goodness it didn't take long for Dr. Karai to perform their consultation. If I was coding this pathology I would be assigning L98.6 "other infiltrative disorders of the skin and subcutaneous tissue". The reason I state that is because I know that I cannot code the "consistent with" per ICD Guidelines but I know that from the pathology reports that I have a skin specimen and a infiltrate was identified so I would be alright assigning L98.6 for this accession.
I know we didn't get an opportunity to discuss the (current, remission, and relapse question you had in your initial post based on the findings for this accession). But, if you have another pathology example you would like to share, please do so.
Thanks,
Dana
 
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