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Re-excision malignant melanoma

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I am looking for some advise on coding a re-excision of a previously diagnosed malignant melanoma. Our surgeon didn't do the original excision, he is just doing the re-excision and the pathology came back stating that no malignant neoplasm was found. So my question is, do I code the claim as malignant and attach 78 mod even if we didn't do the original or do I code it as a benign since the path came back. I am leaning toward the malignant code, but not the modifier since it is out of the post op period and we didn't even do the original excision.
 

mitchellde

True Blue
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13,538
Location
Columbia, MO
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2
If the original path showed malignancy then the reason for the second excision is probably due to positive margins, hence the need for a re excisions, therefore the necessity for the re-excision is the malignancy, the clean path for the second excision is showing that there is no malignancy remaining and the specimen submitted is clear which is what was desired so good news. But you have the path for the re excision which is malignant.
 

Susan

Expert
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463
Location
Chandler, AZ
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I am looking for some advise on coding a re-excision of a previously diagnosed malignant melanoma. Our surgeon didn't do the original excision, he is just doing the re-excision and the pathology came back stating that no malignant neoplasm was found. So my question is, do I code the claim as malignant and attach 78 mod even if we didn't do the original or do I code it as a benign since the path came back. I am leaning toward the malignant code, but not the modifier since it is out of the post op period and we didn't even do the original excision.

First Debra is correct in that your ICD code would still be the melanoma 172.x. Regarding the modifier you would not use any modifier first because you indicated that the patient is out of global. If the patient was in global and the original surgeon shares the same tax id number as your surgeon, then you could apply modifier -58 for staged because the intent was to remove the cancer and re-excise if margins came back positive.
 
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