Wiki Medicare Policy For Benign Lesion Removal

Fort Scott, KS
Best answers
Does anyone else have an issue with the Medicare policy(Kansas) for benign lesion removals? It lists shaving codes 11300 thru 11313 as only covered with benign diagnosis codes only. I don't think this should be policy because if you do a shave, you do not know if the lesion is benign or malignant until you get the path report back. The physician may think the lesion LOOKS benign but then returns from pathology as malignant. We have claims denying. Any suggestions?

Christie Thomas-CPC,PCS
Mercy Physicians Group
620-223-4100 ext 4161
I'm not familiar with your state, but out of curosity, could your provider not select ICD-9 code 238.2. If he felt it was necessary to submit the lesion for bx, then he must had reservations about it being benign? It can be hard to share advice w/o the seeing the documentation/method of removal, etc. I believe I have located you local medical review policy. You're thoughts?

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My provider removed a lesion by shaving. The lesion was sent to pathology and it turned out to be malignant. The Medicare policy for the CPT code only allows diagnosis codes that are benign. I don't think this range of codes belong in this policy because the CPT code book does not state this group of codes as benign removals only. I also do not feel I should use 238.2 because we do have a definite pathological diagnosis. I don't believe in the fact that the physician was suspicious either because I have seen multiple encounters where the physician writes basal cell on the encounter and the path returns as something else. All encounters are not coded until path report is complete.

Christie Thomas-CPC,PCS
Since you're doing a shaving and you biopsy the lesion, could you select 11100...this also includes the shaving method. I able unable to access the lmrp; looks as if their doing some updates.