Question Better understanding I.A.19 ICD-10-CM guidelines

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Good evening,
I would like to gain a better understanding of how to handle the case when a provider documents a neoplasm of uncertain behavior as a diagnosis during the same encounter when a biopsy is performed on a lesion and a pathology report isn't yet available to verify the diagnosis. I would also like to know if guidelines I.A.19 Code assignment and clinical criteria can be applied to this situation and if so, why or how. Thank you
 

sls314

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Good evening,
I would like to gain a better understanding of how to handle the case when a provider documents a neoplasm of uncertain behavior as a diagnosis during the same encounter when a biopsy is performed on a lesion and a pathology report isn't yet available to verify the diagnosis. I would also like to know if guidelines I.A.19 Code assignment and clinical criteria can be applied to this situation and if so, why or how. Thank you

No, the guidelines I.A.19 does not apply to this situation.

If the pathology is not back yet, you would not use the uncertain behavior code. Uncertain behavior codes are only used when the pathologist cannot determine whether a neoplasm is malignant or benign.

Below is an excerpt from the Oncology and Hematology Coding Alert, March 2022 issue:

Uncertain behavior codes should be used in circumstances where a pathologist’s report specifically states that the histologic behavior of the cancer cannot be determined or predicted based on current testing. In other words, you will only assign a code such as D49.59 (Neoplasm of unspecified behavior of other genitourinary organ) if the pathology report states the specimen’s behavior is uncertain. This would be because the pathologist cannot provide “histologic confirmation whether the neoplasm is malignant or benign,” per the note for the D37-D48 codes.
 
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No, the guidelines I.A.19 does not apply to this situation.

If the pathology is not back yet, you would not use the uncertain behavior code. Uncertain behavior codes are only used when the pathologist cannot determine whether a neoplasm is malignant or benign.

Below is an excerpt from the Oncology and Hematology Coding Alert, March 2022 issue:

Uncertain behavior codes should be used in circumstances where a pathologist’s report specifically states that the histologic behavior of the cancer cannot be determined or predicted based on current testing. In other words, you will only assign a code such as D49.59 (Neoplasm of unspecified behavior of other genitourinary organ) if the pathology report states the specimen’s behavior is uncertain. This would be because the pathologist cannot provide “histologic confirmation whether the neoplasm is malignant or benign,” per the note for the D37-D48 codes.
Thank you so much. I feel bothered so much by this since I'm working in a skin clinic outpatient, and most diagnoses the used Neoplasm of uncertain behavior when a biopsy is performed. I am worried that I make the mistake of not using Neoplasm of Uncertain behavior per the documentation provided while pathology isn't yet released because of the guidelines I.A.19.
 

thomas7331

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Thank you so much. I feel bothered so much by this since I'm working in a skin clinic outpatient, and most diagnoses the used Neoplasm of uncertain behavior when a biopsy is performed. I am worried that I make the mistake of not using Neoplasm of Uncertain behavior per the documentation provided while pathology isn't yet released because of the guidelines I.A.19.
This is a common error that a lot of dermatologists make (and have been making for many years) likely because of incorrect coding guidance that's been given to them in the past. 'Neoplasm of uncertain behavior' is not the same thing as, and not the correct way to code, a 'lesion of uncertain diagnosis'. If you're in a position to educate your providers about coding, try to make this clear - they shouldn't be documenting a neoplasm diagnosis without pathology that indicates that the lesions is due to a neoplastic process. You can't tell that a lesion is a neoplasm without pathology.
 

TThivierge

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Hi MetooDavis,:)
Here is a list of common skin ds. I do use my Encoder and ICD10 manual but this helps too. And look in the blocks of dx of specific areas: arm vs leg vs face. I hope this list of common dx skin integumentary helps you.

Cyst Epidermal inclusion L72.0 Erythematous Redness Conditions L53.9 Skin Tags L91

Scalp Lesion L72.3 Atopic Dermatitis inflamed skin L20.0 Carbuncles (boils ) L02

Pilar Cyst L05 Inflamed Keratosis seborrh. L82.0 Shaving Bumps on skin dx L73.1 Pseudo. Bar. Follicitis

Follicular Cyst L72.8 Skin Infections L08.9 Sunburn L55

Pilonidal Cyst L05 Pruritus Itching L29.8 Alopecia L66

Skin abscess L02.416 or open wound S91.3 Pressure Ulcers L98 Cellulitis L03

Blister Pemphigus L10.0 Dry skin Xerosis L85.3 Sebaceous Cyst on scalp L72.3

Skin changes R23.4

Warts dx B07 or L82 Benign Neoplasms D21-D25

Lipoma D17 Skin Mass or lumps R22

Nail Disorders L60 Corns & Callouses L84

History of Skin DO Z87.2 M. Nevi (moles) D22

Skin CA C44 block Boils under arm pits Hidradentis Supp L73.2

Encounter Malignant Skin Z12.83
Personal History of Benign Neoplasm Z86.018 Personal HO of Skin CA Z87.2

Lady T
:)
 
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