Shave bx, path = basal cell carcinoma

ssprinkle

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Dr. shaved lesion, face, 1.0 cm and pathology came back basal cell ca. Should this be coded 11311 or do I go to 11641?
Any advice and reference to written material greatly appreciated....
 

mitchellde

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you cannot use an excision code if a shave is what was performed. The difference between a shave and an excision is depth not pathology. If the procedure note states and describes a shave then you must code it as such, if the procedure note describes and states an excision then it must be coded as such.
A shave removes the visible anomaly to a depth of partial thickness and an excision removes the lesion to a depth of full thickness.
Partial thickness- into but not thru the dermal layer
Full thickness- thru the dermal layer and into or thru the subq layer.

These are not interchangeable terms.
 

grth97

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I am having the same issue. I know I must bill what was performed but the dx code does not support the procedure code and will not be paid by Medicare. My provider is telling me to code 238.2 as the dx because she did not know it was ca at the time of removal. I disagree with the dx 238.2 (another can of worms I will have to open) but can I use 709.9 or 239.2 as the primary and then code the 173._ _ as the secondary code?
 

mitchellde

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238.x is not a code for use when the provider does not know what the path will reveal. It is in and of itself a dx based on pathology. 239.x is a code that can be used based on a preliminary diagnostic study that reveals a tumor but has no path yet. You cannot code the symptom 709.9 once you have the definitive dx. If this is an excision then I am not seeing why the code does not match. If it is a biopsy then you do not have to wait for a path and you can code the symptom of the 709.8
 

grth97

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173._ _ is not listed as a payable dx code in the LCD. This is where I am stuck on what to code. I have questioned the provider to change to 11100 but she has declined stating the lesion was removed. Below are the notes.


There is a 7 mm erythematous hyperkeratotic indurated papule on the left mid-lower back.

Lesion of uncertain behavior, concerning for carcinoma, located on the left mid-lower back
PROCEDURE: After the risk of bleeding, infection, pain, scarring and possible need for further procedures were reviewed, the patient verbally consented to shave removal. The area was cleansed with alcohol, anesthetized with buffered 2% lidocaine with epinephrine 1:100,000 and shave removed to remove the entire visible lesion. Specimen was placed in formalin and labeled for pathology. Aluminum chloride was used for hemostasis. Plain Vaseline and a bandage were applied. Postprocedure expectations and wound care were discussed and provided in written form. We will correspond with the patient in seven to ten days regarding the results of these biopsies. Followup and further management will be based on the pathology results.

Final Pathologic Diagnosis
Skin, left mid back, shave biopsy: Squamous cell carcinoma in situ
 

mitchellde

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Ah, no you cannot code a shave removal as a biopsy, use the V71.1 as your first listed code and the Ca in situ as your secondary.
 

grth97

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I have reviewed the V71.1 and now I do not believe I can use it. It states..

This category is to be used when persons without a diagnosis are suspected of having an abnormal condition, without signs or symptoms, which requires study, but after examination and observation, is found not to exist. This category is also for use for administrative and legal observation status.

I believe this would work if a patient had a lesion removed and the insurance would deny it due to cosmetic reasons because it was benign, but we suspected malignancy and FOUND malignancy with a benign excision.

Am I reading too much into it? :confused:
 

mitchellde

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I have reviewed the V71.1 and now I do not believe I can use it. It states..

This category is to be used when persons without a diagnosis are suspected of having an abnormal condition, without signs or symptoms, which requires study, but after examination and observation, is found not to exist. This category is also for use for administrative and legal observation status.

I believe this would work if a patient had a lesion removed and the insurance would deny it due to cosmetic reasons because it was benign, but we suspected malignancy and FOUND malignancy with a benign excision.

Am I reading too much into it? :confused:
you stated the path was ca in situ. this is not a malignancy since it was insitu there will be no progression of the disease. Malignancy is a process which progresses and metasticizes therefore from what you post you suspected malignancy and found insitu, which is not malignant.
from the medical dictionary:
Many forms of invasive carcinoma (the most common form of cancer) originate after progression of a CIS lesion.[1] Therefore, CIS is considered a precursor or incipient form of cancer that may, if left untreated long enough, transform into a malignant neoplasm.
 
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mitchellde

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I would not use V71.1

But why not? It explains the reason for the removal beautifully. It is first listed only allowed. I worked in the cancer center for several years and this code was used often and for situations just like this one. there is no problem with it. I am just wondering why you do not feel it is appropriate.
 
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