Coding keratoacanthoma

jyoung

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I have a coding question, I am hoping you can assist. My physician's experience has been that a keratoacanthoma is a variant of a squamous cell carcinoma (i.e., malignant), so excision of keratoacanthomas would be coded as an excision of a malignant lesion, subtyped by location and size.

ICD10 officially lists "keratoacanthoma" as a BENIGN "thickening of the skin", thus medicare (and insurers) would code as a benign excision. Here is a link to some discussion of this topic through AAPC: https://www.aapc.com/memberarea/foru...hickening.html.

The pathologist we use (a certified dematopathologist) always reports on whether the margins of a keratoacanthoma are clear or not, which he does only with malignant lesions, not benign lesions. Coders at our office are telling us this is a benign excision.

What do you think? Do you think it would be as simple as having the pathologist report it as "keratoacanthoma variant of squamous cell carcinoma" on the report, to show in case of audit? Thank you for your feedback!
 

CatchTheWind

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Take a look at the "similar threads" links just below this. There's no good answer to the keratoacanthoma issue, but those threads will give you a look at previous discussions about it.
 

CatchTheWind

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I just had a discussion with our EMR vendor about this. Their stance is that since (a) many (most?) dermatologists consider keratoacanthoma a form of squamous cell carcinoma; (b) the literature supports performing malignant excisions, destruction, and Mohs on it; and (c) ICD-10 is actually somewhat ambiguous about how to code it (it lists it under a benign code in the alphabetic list, but does not cross-reference it under that benign code (or any code at all) in the tablular list), we should be able to justify coding it as a squamous cell carcinoma and bill malignant excisions with it.

I would suggest, however, that you ask the pathologist you work with to make it clear in the path report that this is (or is considered by some to be) a form of squamous cell carcinoma.
 
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