Wiki Nail bx icd-10 question

[LeticiaS]

I am curious to see the answers i will get. But I have a Path report:

I was told to use L60.9 (Nail disorder, unspecified) BUT also i am torn to use Z03.89 (Encounter for observation for other suspected diseases and conditions ruled out) instead because L60.9 is a disease code and the specimen doesn't state anything signs or symptoms to indicate to use L60.9. So the Z03.89 code, seems to be more appropriate code to use as this code is more of a rule-out coding, not disease coding. What are your thoughts? Thanks!

 

[sls314]

I am curious to see the answers i will get. But I have a Path report: View attachment 8324

I was told to use L60.9 (Nail disorder, unspecified) BUT also i am torn to use Z03.89 (Encounter for observation for other suspected diseases and conditions ruled out) instead because L60.9 is a disease code and the specimen doesn't state anything signs or symptoms to indicate to use L60.9. So the Z03.89 code, seems to be more appropriate code to use as this code is more of a rule-out coding, not disease coding. What are your thoughts? Thanks!

I would not use Z03.89. Is the pathologist observing the patient for a suspected medical condition, or did the pathologist process a sample with negative findings?

The ICD-10-CM guidelines will give you guidance on the Z03 category of codes:


(left out some of the middle excerpt about maternal/fetal observation as it's irrelevant to this situation)








Why was the nail specimen sent to pathology in the first place? I'm assuming they don't routinely send everyone's nails down to be examined. There's a reason that the physician wanted the sample examined for fungus. So...what was that reason?


FWIW, it's possible L60.9 may be the appropriate code. Sometimes the index does direct you to unspecified disorder codes when the symptom doesn't have a more specific code. (For example, liver lesion indexes to K76.9 - liver disease, unspecified. Even though the lesion might be totally inoccuous and not the result of a disease.)

 

[danachock]

Hello LeticiaS,
The pathology report provides no indication here unless you have access to other information from the patient's medical record elsewhere within their health record.
My very first cardinal rule of pathology coding is just because someone tells you to slap on a diagnosis code that is not documented to just kick the claim out the door is the furthest from the truth coding here. Oh gosh no, not happening here. My name is on those charges. I had better be darn sure why I selected the CPT codes and diagnosis codes here.
Unless it is absolutely documented, it didn't happen for this pathology accession. I don't see it. Please chime in if you think I missed something here.
I see a nail specimen a special stain and no abnormalities found. You would need to fall on the clinical history here. Why was the specimen delivered to your pathology department for review. If you have no clinical history or indication to code from that is a CMS and probably compliance issue per APF manual (our Pathology Coding Bible).

diagnosis codes, diagnosis coding