Wiki Benign excision, path came back malignant, code malignant excision?

[Akulo]

I'm reading that when we do a benign excision, we wait for the path and it comes back to be malignant, we should still code the benign excision code because that's what was done in the first place.

I read others that say to code it as a malignant excision just because the path came back to be malignant.

Which one is correct?

Also a global question, since the path came back unexpectedly to be "LEIOMYOSARCOMA" (we initially thought it was a benign cyst) can we bill a separate e/m within the global from the excision since the growth turned out to A LOT more serious than we originally thought and we have to have a long discussion with the patient about it?

 

[AprilSueMadison]

You always code excisions based off of the pathology. You should hold these until you get the final diagnosis back and then submit it. If it is a cancerous diagnosis, you'll use a malignant code. If benign, then benign CPT excision code.

 

[Akulo]

But since it came back completely unexpectedly to be malignant, if the patient came back within the global to discuss in detail about the path result, is it billable with modifier 24? It was thought to be a cyst but it turns out to be something that can potentially kill the patient.