Wiki How to code mixed dx on skin lesion Path Report

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ccr888

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Can anyone please share thoughts/expertise regarding these two skin lesion pathology reports with multiple components?

1) bx path: Lentiginous Compound Dysplastic Nevus with Moderate Atypia, extending to peripheral margin

2) excision path: Lentiginous Junctional Dysplastic Nevus with Moderate to Focal Severe Atypia

I see no chart documentation of melanomas or family hx of same.

ICD-10 index search leads me to: D23.5

I am unsure if my code choice is correct...any comments?
 
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P.S. #1 above is documented as "irregularly pigmented lesion suspicious for melanoma" and pathology recommended complete excision for microscopic examination, which returned with "Residual Dysplastic Nevus" pathology
#2 above is documented as "deeply pigmented, slightly irregular lesion" and "somewhat suspicious because of its heavy pigmentation"

Is there some way to code for medical necessity from this documentation?

Thanks again for any comments!
 
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I believe we have a similar question. Path report came back as compound nevus with mild to moderate atypia. Following path in code book it leads you to D22 but our provider disagrees with benign neoplasm diagnosis. He states it is premalignant. I have found information that states atypia another way of stating uncertain so I am thinking about diagnosis D48.5 neoplasm of uncertain behavior.

Any thoughts?
Thank you for any information you can provide!
 
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I see some very old Coding Clinic guidance from ICD-9 that an 'atypical meningioma' would be coded as a 'neoplasm of uncertain behavior', but nothing more recent or specific to this situation. I think there is an argument to be made either way on this - it's all in how you interpret 'atypia'. If your provider is telling you that this pathology report is telling his it is an uncertain diagnosis, then I don't see anything wrong with deferring to his judgment and using that.

But I would remind your provider that a code is not a diagnosis, it is a classification code for reporting purposes - providers often misunderstand this distinction. Since there is no code for 'premalignant' or 'atypia', it has to be classified to something else. Assigning a code D22 or D48 does not give the patient a benign or uncertain diagnosis, it just classifies the actual diagnosis for reporting purposes - the actual diagnosis is always and only what the provider documents in the record.
 
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