Diagnosis R21 with 11104.

[Brandy0618]

May I ask if anyone has issues with reimbursement when you report 11104 and attach R21 (rash)? Via the EMR our provider reports Biopsy-Punch R/O: Tinea Versicolor vs Hailey hailey. This would be before we have a path report. Thank you to any advise.

 

[sls314]

Hello use D48.5 for 11104.

ABSOLUTELY DO NOT DO THIS!

You cannot use an "uncertain behavior" diagnosis without a pathologist specifically stating that is uncertain. (Meaning that the pathologist has looked at the sample and cannot clinically determine whether it is benign or malignant.)

ONLY a pathologist can make that determination and that code should NEVER be used otherwise.

 

[danachock]

Hello, I have something to share on this please.
This is what I stated on this very same scenario back in 2020. https://www.aapc.com/discuss/threads/neoplasm-of-uncertain-behavior.171932/

I may be able to offer some guidance on this. I just had the opportunity to watch one of our AAPC webinars a few days ago that actually touched on this very topic "Anatomy and Pathophysiology of Neoplasms" by Sheri Poe Bernard, CPC, CRC, CDEO, CCS-P that may offer some guidance that I wanted to share.
Yes, the dermatology providers do utilize the microscope, but I cannot validate that it is utilized every single time a biopsy or otherwise is performed on a patient.
Per my handwritten notes "uncertain behavior" was discussed to explain that "Categories D37-D44 and D48 classify by site the neoplasms of uncertain behavior - this requires the histologic confirmation (use of microscope) on whether the neoplasm is malignant or benign simply cannot be made."
Again, as I stated earlier - I am unsure if microscopic is performed on every specimen acquired by a dermatologist or not prior to submitting the specimen to the pathology department for review, so I am unsure whether or not it is appropriate for them to assign D37-D44 and D48 to a specimen unless they have personally reviewed it microscopically first before sending it.

If in the event that it is not reviewed by a microscope by the dermatologist prior to being sent to the pathology department for review they would want to utilize the unspecified behavior diagnosis code because we would want to reserve those codes listed above (D37-D44 along with D48) for microscopic evaluation first.

However, if we had clear indication that it was reviewed by microscope by the dermatologist than we would want to utilize D48.5 for this very scenario.
I am hopeful someone coding dermopathy field may step in and participate and tell us exactly what is happening possibly at their facility.

The Dermatologist can make this decision prior to sending this specimen(s) to the pathology department for review because they are "utilizing a microscope". A little more information is needed please. I hear and also actually personally see the "woes" on this coding scenario and would love the opinion of a dermatology professional on this type of scenario. But if facilities are utilizing D48.5 as a sense their "default code" ~ that is absolutely incorrect in my opinion.
Thank you for listening and have a great evening!
Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT

.

 

[sls314]

Hello, I have something to share on this please.
This is what I stated on this very same scenario back in 2020. https://www.aapc.com/discuss/threads/neoplasm-of-uncertain-behavior.171932/

I may be able to offer some guidance on this. I just had the opportunity to watch one of our AAPC webinars a few days ago that actually touched on this very topic "Anatomy and Pathophysiology of Neoplasms" by Sheri Poe Bernard, CPC, CRC, CDEO, CCS-P that may offer some guidance that I wanted to share.
Yes, the dermatology providers do utilize the microscope, but I cannot validate that it is utilized every single time a biopsy or otherwise is performed on a patient.
Per my handwritten notes "uncertain behavior" was discussed to explain that "Categories D37-D44 and D48 classify by site the neoplasms of uncertain behavior - this requires the histologic confirmation (use of microscope) on whether the neoplasm is malignant or benign simply cannot be made."
Again, as I stated earlier - I am unsure if microscopic is performed on every specimen acquired by a dermatologist or not prior to submitting the specimen to the pathology department for review, so I am unsure whether or not it is appropriate for them to assign D37-D44 and D48 to a specimen unless they have personally reviewed it microscopically first before sending it.

If in the event that it is not reviewed by a microscope by the dermatologist prior to being sent to the pathology department for review they would want to utilize the unspecified behavior diagnosis code because we would want to reserve those codes listed above (D37-D44 along with D48) for microscopic evaluation first.

However, if we had clear indication that it was reviewed by microscope by the dermatologist than we would want to utilize D48.5 for this very scenario.
I am hopeful someone coding dermopathy field may step in and participate and tell us exactly what is happening possibly at their facility.

The Dermatologist can make this decision prior to sending this specimen(s) to the pathology department for review because they are "utilizing a microscope". A little more information is needed please. I hear and also actually personally see the "woes" on this coding scenario and would love the opinion of a dermatology professional on this type of scenario. But if facilities are utilizing D48.5 as a sense their "default code" ~ that is absolutely incorrect in my opinion.
Thank you for listening and have a great evening!
Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT

.

That is a good point. I did not have the impression that this was a scenario where it was reviewed in office under a microscrope by a dermatopathologist.

However, I should have referenced that as a possibility as well when I mentioned not to use the "uncertain behavior" codes without a pathologist confirmation. The code should absolutely not be used routinely, but could be diagnosed by a pathologist or dermatopathologist.

 

[Brandy0618]

Hello, I have something to share on this please.
This is what I stated on this very same scenario back in 2020. https://www.aapc.com/discuss/threads/neoplasm-of-uncertain-behavior.171932/

I may be able to offer some guidance on this. I just had the opportunity to watch one of our AAPC webinars a few days ago that actually touched on this very topic "Anatomy and Pathophysiology of Neoplasms" by Sheri Poe Bernard, CPC, CRC, CDEO, CCS-P that may offer some guidance that I wanted to share.
Yes, the dermatology providers do utilize the microscope, but I cannot validate that it is utilized every single time a biopsy or otherwise is performed on a patient.
Per my handwritten notes "uncertain behavior" was discussed to explain that "Categories D37-D44 and D48 classify by site the neoplasms of uncertain behavior - this requires the histologic confirmation (use of microscope) on whether the neoplasm is malignant or benign simply cannot be made."
Again, as I stated earlier - I am unsure if microscopic is performed on every specimen acquired by a dermatologist or not prior to submitting the specimen to the pathology department for review, so I am unsure whether or not it is appropriate for them to assign D37-D44 and D48 to a specimen unless they have personally reviewed it microscopically first before sending it.

If in the event that it is not reviewed by a microscope by the dermatologist prior to being sent to the pathology department for review they would want to utilize the unspecified behavior diagnosis code because we would want to reserve those codes listed above (D37-D44 along with D48) for microscopic evaluation first.

However, if we had clear indication that it was reviewed by microscope by the dermatologist than we would want to utilize D48.5 for this very scenario.
I am hopeful someone coding dermopathy field may step in and participate and tell us exactly what is happening possibly at their facility.

The Dermatologist can make this decision prior to sending this specimen(s) to the pathology department for review because they are "utilizing a microscope". A little more information is needed please. I hear and also actually personally see the "woes" on this coding scenario and would love the opinion of a dermatology professional on this type of scenario. But if facilities are utilizing D48.5 as a sense their "default code" ~ that is absolutely incorrect in my opinion.
Thank you for listening and have a great evening!
Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT

.

My question was has anyone had issues with getting reimbursement for 11104 when filed with rash diagnosis code of R21. We cannot get carriers to honor this diagnosis code. I have researched and researched trying to find an option via diagnosis code when our providers are trying to rule our specific skin rashes and they have no idea what it is yet. It is not a neoplasm but a rash. Thank you.