Shave removal of lesion that comes back malignant

grth97

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I have gone through many post about this subject and cannot find a clear answer. I went to a derm coding site called dermlist and was told that if the provider performs a shave removal and the path comes back malignant we could change the procedure code to a destruction code if the base of the lesion was treated.

Has anyone heard of this?
 

mitchellde

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No you cannot substitute one procedure for another. The intent of the original procedure was a shave removal, that is what was performed. The dx does not change the procedure.
 

jholt12

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I have used the excision of a benign lesion codes (11400-11446) and waited for path to come back only to be malignant and billed the excisions of malignant lesion codes (11600-11646). No for a shaved removal though.
 

mitchellde

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I have used the excision of a benign lesion codes (11400-11446) and waited for path to come back only to be malignant and billed the excisions of malignant lesion codes (11600-11646). No for a shaved removal though.
An excision is not to billed until the path is returned. You do not know it is benign so therefore you cannot make that choice. You hold the claim and wait then bill as malignant if malignant path and benign as benign path. Shaves as you stated no they do not come as flavors benign or malignant and cannot be converted into any other removal type.
 

grth97

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Here is the second documentation I have found to back up changing the shave to destruction as long as the base was treated when the path comes back malignant. I am going to keep searching and will post anything I find. Medicare will not pay for the shave removal with a malignant dx. And like I said before V71.1 would not be correct since the description states not found and per path it was found. To me the intent of the provider was to get rid of the lesion and both a shave and destruction was performed but of course you cannot code two procedures. This is obviously a huge question with many different answers. Just not sure what the correct one is.

http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=712296
 

mitchellde

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if this is in regard to the Ca in situ then as I stated this is not a malignancy so the V71.1 would be appropriate. It all goes to intent of the procedure, if the intent was to remove the lesion to discover what it is then it is a shave removal, if the intent was to eradicate the anomaly then I can go with destruction, but the procedure note would need to clearly reflect this was the intent. If the path was not CA in situ but was say a basal cell carcinoma, then you are correct the V71.1 is inappropriate as a dx code. It is unfortunate that the basal cell code does not allow for payment of the procedure. I am curious did you receive a denial? and did the denial state the procedure was inconsistent with the dx code?
 

grth97

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Yes it was basal cell carcinoma. We wait for the path to come back before we bill anything and then code the dx accordingly. Our software is holding the claim due to it not being a payable dx for the procedure code so it has not gone out and been denied yet. I have two claims with the same situation. Not sure what to do but the provider should be paid for services rendered. Still at a loss. :(
 

mitchellde

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I was curious because I have been paid using a basal cell code with a shave, is it possible your software is incorrect? Can you go ahead and release the claim anyway and let the payer make a decision to pay or deny?
I was questioning the dx as there is a similar post but regarding an in situ pathology which is different.
you could not use a destruction if the path were basal cell as there are residual cancer cells to think about so the cancer was not destructed.
 

grth97

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The other claim I have in question is carcinoma in situ. 232._ is not listed as a paybale dx per LCD either. I have tried to put V71.1 on that claim and V71.1 is not a payable dx as well. Carcinoma in situ is an early form of cancer that has stayed at the surface and not reached the basement membrane so I don't believe V71.1 would be appropriate for this either. I have manually checked the LCD and the system is correct. Was you payment through Medicare or commercial? I believe we have had payment from commercial before but Medicare of course is a whole other story.
 

mitchellde

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Medicare has paid using the V71.1 numerous times. CA in Situ is actually considered a precancerous condition that is not malignant but could develop that way. Therefore at this stage is nonmalignant which is why the V71.1 is allowable. Just because a dx is not on an LCD does not mean it is not payable. Some LCDs are restrictive that way but not all of them. A lot of them are written to say "will be payable with dx codes SUCH AS" which is truely very different.
 
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