naandersn
Guest
If the pathology comes back as "Keratoacanthoma" uncertain behavior........should the benign excision codes be used?
You choose benign excision vs. malignant excision according to diagnosis, not margin size. Benign excision would be correct, unless the Pathologist indicated evidence if squamous cell carcinoma or scc in situ, then you would bill malignant excision.
You choose benign excision vs. malignant excision according to diagnosis, not margin size. Benign excision would be correct, unless the Pathologist indicated evidence if squamous cell carcinoma or scc in situ, then you would bill malignant excision.
It was several years ago probably in the 1980s. If anyone does have it the only information they could give is the issue number and year and a brief synopsis of the information in their own words. However that should be sufficient information. As far as I know there was not a more recent Assistant with this information nor was it ever overruled.
you are awesome!!here is what i found from cpt assistant may 1996:
Surgery/ integumentary
question
when a lesion is removed that turns out to be a neoplasm of uncertain morphology (eg, melanoma vs dysplastic nevi), is it correct to use excision of benign neoplasm rather than excision of malignant neoplasm?
Ama comment
"uncertain behavior" identifies tissue that is beginning to exhibit neoplastic behavior but cannot yet be categorized as benign or malignant. Additional or further testing is required. To ensure correct coding, the removal of the neoplasm should be coded after receiving the pathology report.
When the morphology of a lesion is ambiguous, choosing the correct cpt procedure code relates to the manner in which the lesion was approached rather than the final pathologic diagnosis, since the cpt code should reflect the knowledge, skill, time, and effort that the physician invested in the excision of the lesion. Therefore, an ambiguous but low suspicion lesion might be excised with minimal surrounding grossly normal skin/soft tissue margins, as for a benign lesion (codes 11400-11446), whereas an ambiguous but moderate-to- high suspicion lesion would be excised with moderate-to- wide surrounding grossly normal skin/soft tissue margins, as for a malignant lesion (codes 11600-11646). Thus, the cpt code that best describes the procedure as performed should be chosen.
(no revisions to date)