Excision of benign lesions

[ekreich@suddenlink.net]

I have a claim for cpt 11440 excision of benign lesions with dx of 692.72.
The claim is not getting passed our cleaninghouse-any suggestions?

 

[mitchellde]

you cannot bill a benign excision without a path report which means you will have a path dx code.
Your medical necessity does not support an excision code.

 

[jroxas]

Hi
Check your ICD 9 692.72. Your CPT is excision. Did you have pathology result? , Neoplasm, hemangioma, lipoma , are some of the matched payable codes
Jerry Roxas, CPC

 

[CatchTheWind]

I disagree about requiring a path report. If the doctor made a clinical diagnosis that this is a benign lesion, then it's a benign lesion.

The problem I see is that 692.72 is NOT a benign lesion; it is dermatitis. You can't excise dermatitis. It seems that you have the wrong diagnosis code.

 

[mitchellde]

The coder may not assume benign and code without a path report. I have never had a provider document an abnormality as benign unless this was proven by path. Either way the coder may code based only on provider diagnosis. And not use a benign excision unless specifically documented as benign. However to address your objection, a provider does not truely know if an abnormality is benign without definitive path.

 

[CatchTheWind]

I agree that the coder cannot make the assumption that it is benign. But my providers regularly document lesions as benign based on their clinical observation, and I can code "benign destruction" or "benign excision" based on this documentation.

 

[cohela]

New to Dermatology

In regards to an excicion being performed and the dx is 709.9 when path report comes back and shows 173.32 how should the Dr code this?
Also, my additional question is if a biopsy is performed and dx 709.9 and path report comes back saying 173.32, should the charge change to code malignant or code as what physician coded initially (709.9)
Thanks

 

[mitchellde]

In regards to an excicion being performed and the dx is 709.9 when path report comes back and shows 173.32 how should the Dr code this?
Also, my additional question is if a biopsy is performed and dx 709.9 and path report comes back saying 173.32, should the charge change to code malignant or code as what physician coded initially (709.9)
Thanks

You held the claim to wait for the result which is a malignancy so code the malignant excision code.
The biopsy may be submitted with the 709.9 or you may hold it and wait for the path if the claim was held submoit the biopsy procedure code with the 173.32 dx code.

 

[Texascoder64]

this discussion sparks my interest as well and I need some supporting information. If a physician does their own coding and on the initial visit selects a 114xx as being the procedure performed, then the "biller" holds the claim until path is read and the dx is: a non skin lesion type dx such as a dermatitis or an SK, and let's say this is billed with this type of cpt and dx, would be questionable for medical necessity ?

 

[jroxas]

Hi
Pathology result is still the basis for your final CPT. Clinically it looks benign, what if the pathology turns out to be malignant? You have to recode to codes in the 11600 series.
Jerry E. Roxas, CPC