Wiki Derm biopsy

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beedilla80

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Hi All,
Does anyone have any guidance on how to bill for a malignant vs benign biopsy if we are billing before results come back?
 
If you are billing before the path results are available for a biopsy you cannot code either benign or malignant. You code only a skin lesion. Look in the alpha under key word lesion, then skin. A biopsy is a removal of a piece of the lesion. If the entire lesion is removed then it is not a biopsy. If it is an excision you are required to wait for the path report.
 
CatchTheWind said:
The diagnosis code for skin biopsy prior to getting the path report is 239.2
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I disagree. Look in your code book under the sub heading for neoplasm unspecified. It states the term "mass" is not to be interpreted as neoplastic. Mass in quotes means mass and similar terms. A lesion falls under the definition of similar terms. To code a skin lesion you go to key word lesion then skin, you will be directed to 709.9. The term tumor or abnormal growth is code as a 239 code.
 
the aapc pre exam book for derm states to use 239.2 i believe.. but I don't disagree to using 709.9 either. not everything biopsied are neoplasms.
 
The code book instructions, conventions and look up terms will take precedence over the AAPC pre exam book. There is a direct reference in the code book for skin lesion. Therefore you must follow this. You cannot decide to use something different for reimbursement purposes. Perhaps the AAPC should be contacted regarding this, if in fact it does state what you indicate.
 
Most dermatologists, including every office I have worked in, use 238.2. As we discussed in a previous thread, the coding expert at the AAPC has confirmed that there is no problem using 238.2 However, since 239.2 is the more accurate code, that is what I recommended. I don't believe you will find any other coding expert in dermatology who disagrees with the use of 239.2 for lesions being sent for biopsy.
 
CatchTheWind said:
Most dermatologists, including every office I have worked in, use 238.2. As we discussed in a previous thread, the coding expert at the AAPC has confirmed that there is no problem using 238.2 However, since 239.2 is the more accurate code, that is what I recommended. I don't believe you will find any other coding expert in dermatology who disagrees with the use of 239.2 for lesions being sent for biopsy.
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I am going to disagree every time. These are patient codes. The 238 codes were not put here to indicate that the provider is uncertain. They indicate that after a histologic examination it cannot be determined to be benign or malignant. On the ICD-9 book it states that they are histomorphopathologic which means exam under a microscope by pathologist. ICD-10 CM states .. Histolologic confirmation of whether the neoplasm is malignant or benign cannot be determined. Again histologic confirmation is a path report. The definition for the 239 codes is also on the code book as I indicated earlier and specifically states that it cannot be determined to be neoplastic unless specifically indicated by the provider. Again the code book provides a direct reference for skin lesion as the 709.
 
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