we visited this topic at one point a year ago or more but I has come up again. This is a derm office in PA where MediCare LCD doesn't accept D22.XX (Dysplastic Nevi) under the shave codes or excision codes they deny as not necessary as they are benign spots. The process is BX is done on one office visit and sent to pathlogy then it comes back from Pathology as D22.XX and then the Dr calls patient back in to "clear any margins" by doing a shave like a 11301 code or an excision of benign lesion and interm repair. Their reasoning behind it is the patient has history of these and or maybe other skin cancers and taking it all out now would prevent return later for something worse (if that makes sense) however the lab is saying the spot when biopsied is benign? I am not sure where to go with this the dr wants to do the work and be paid for it understandably. Any thoughts on this?
-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki D22.XX codes BX proven for reshave and Excision HELP
ellzeycoding
Guest
- Messages
- 392
- Best answers
- 0
D22 series are for benign (i.e., normal or melanocytic) moles.
They are not atypical or dysplastic.
If the biopsy came back as D22.?, there is no medically necessary reason to remove more of it (re-excision, shave, etc.) after the biopsy. D22.? are benign. That's the whole purpose of doing the biopsy (i.e., to see if the lesion warrants further treatment) or if it meets medical necessity requirements.
They are not atypical or dysplastic.
If the biopsy came back as D22.?, there is no medically necessary reason to remove more of it (re-excision, shave, etc.) after the biopsy. D22.? are benign. That's the whole purpose of doing the biopsy (i.e., to see if the lesion warrants further treatment) or if it meets medical necessity requirements.
Sburton828
New
- Messages
- 9
- Best answers
- 0
Additional question regarding biopsy results and subsequent destruction
First, I just wanted to add that according to the Summer 2017 Derm Coding Consult, dysplactic nevi should be D23.xx. See source material below.
Second, I have a question: If my doc (phys office) says he does an ed&c but the pathology comes back as benign, are we supposed to then code it as a shave removal with D48.5? I question it because the 17110 (+ path) seems to have a better matching definition to the ed&c.
What should I do?
THanks,
SaraB
"Q) What is the proper ICD-10-CM code for dysplastic nevus?
A) The most appropriate answer is, it depends on information contained in the clinical documentation or the pathology report. In ICD-10-CM dysplastic nevi are coded as a benign neoplasm (D23.-). However, should the clinical exam as documented in the medical record or should the pathology report identify uncertainty regarding the malignant potential of the lesion, the more appropriate code to report is D48.5 – neoplasm of uncertain behavior. Documentation of the encounter may also identify lesions suspicious for malignancy based on lesion appearance or in consideration of patient past medical history of malignant neoplasms which increase the likelihood of malignant behavior in the new lesion. In the pathology report, uncertainty may be communicated in terms of differential diagnoses."
First, I just wanted to add that according to the Summer 2017 Derm Coding Consult, dysplactic nevi should be D23.xx. See source material below.
Second, I have a question: If my doc (phys office) says he does an ed&c but the pathology comes back as benign, are we supposed to then code it as a shave removal with D48.5? I question it because the 17110 (+ path) seems to have a better matching definition to the ed&c.
What should I do?
THanks,
SaraB
"Q) What is the proper ICD-10-CM code for dysplastic nevus?
A) The most appropriate answer is, it depends on information contained in the clinical documentation or the pathology report. In ICD-10-CM dysplastic nevi are coded as a benign neoplasm (D23.-). However, should the clinical exam as documented in the medical record or should the pathology report identify uncertainty regarding the malignant potential of the lesion, the more appropriate code to report is D48.5 – neoplasm of uncertain behavior. Documentation of the encounter may also identify lesions suspicious for malignancy based on lesion appearance or in consideration of patient past medical history of malignant neoplasms which increase the likelihood of malignant behavior in the new lesion. In the pathology report, uncertainty may be communicated in terms of differential diagnoses."
mitchellde
True Blue
You cannot code D48.5 without a path report and you cannot use D48.5 if the path report indicates benign pathology. D48 codes are to be used with pathology when the path result indicates uncertain or atypical result. You cannot use D48 when the provider is performing a removal to determine if the lesion is benign or malignant.
Sburton828
New
- Messages
- 9
- Best answers
- 0
What about the CPT code?
Thank you for the above response.
Would you "down code" the ED&C to a shave if the path came back as benign? How do you bill for this?
Also, we were trying to send the shave and biopsies with D49.2 and they were all coming back denied. What would you suggest?
Thanks,
SaraB
Thank you for the above response.
Would you "down code" the ED&C to a shave if the path came back as benign? How do you bill for this?
Also, we were trying to send the shave and biopsies with D49.2 and they were all coming back denied. What would you suggest?
Thanks,
SaraB
mitchellde
True Blue
If the path comes back as benign then you must code it as benign. You cannot use D49 for unspecified since it is specified as benign. You should never downcode a procedure. You can however use Z03.89 as your first listed code indicating a diagnosis ruled out and use the code for benign neoplasm secondary. This is how I have always coded these and I have never had an issue with reimbursement. For the shave and biopsies, if you do not have a path report you cannot use either D48 or D49 codes. You will need to use the L98.9 for unspecified skin disorder since that is all that is known without a path report. Most often these will be denied. Therefore waiting for a path report is the best option.
Last edited: