mitchellde
True Blue
Given more than a few posts regarding L27362 regarding the coding of lesion removals, I requested clarification from John Verhovshek at the AAPC. This LCD was revise and effective 06/05/09. The new language while not perfect is tremendously better than before.:
Each claim must be submitted with ICD-9-CM codes that reflect the condition of the patient, and indicate the reason(s) for which the service was performed. Claims submitted without ICD-9-CM codes will be returned.
While it is recognized that some diagnoses resulting from an excision will at times be malignant, the diagnosis at the time the procedure was performed would most likely be 239.2 (Neoplasms of unspecified nature, bone, soft tissue, and skin), and this would be the appropriate code, since proper coding requires the highest level of diagnosis known at the time the procedure was performed.
Medical records maintained by the physician must clearly document the medical necessity for the lesion removal(s) if Medicare is billed for the service....
The decision to submit a specimen for pathologic interpretation will be independent of the decision to remove or not remove the lesion. It is assumed, however, that a tissue diagnosis will be part of the medical record when an ultimately benign lesion is removed based on physician uncertainty as to the final clinical diagnosis.
But please note again they say to use 239.x not 238.x and that is an important distinction. So now they do not specify to code benign prior to pathology and I feel good still about waiting for the final path before coding the claim.
Mr. Verhovshek went on to state "The AAPC was instrumental in working for a change on this, and the language above is less clear than was promised".
Debra Mitchell, MSPH, CPC-H
Each claim must be submitted with ICD-9-CM codes that reflect the condition of the patient, and indicate the reason(s) for which the service was performed. Claims submitted without ICD-9-CM codes will be returned.
While it is recognized that some diagnoses resulting from an excision will at times be malignant, the diagnosis at the time the procedure was performed would most likely be 239.2 (Neoplasms of unspecified nature, bone, soft tissue, and skin), and this would be the appropriate code, since proper coding requires the highest level of diagnosis known at the time the procedure was performed.
Medical records maintained by the physician must clearly document the medical necessity for the lesion removal(s) if Medicare is billed for the service....
The decision to submit a specimen for pathologic interpretation will be independent of the decision to remove or not remove the lesion. It is assumed, however, that a tissue diagnosis will be part of the medical record when an ultimately benign lesion is removed based on physician uncertainty as to the final clinical diagnosis.
But please note again they say to use 239.x not 238.x and that is an important distinction. So now they do not specify to code benign prior to pathology and I feel good still about waiting for the final path before coding the claim.
Mr. Verhovshek went on to state "The AAPC was instrumental in working for a change on this, and the language above is less clear than was promised".
Debra Mitchell, MSPH, CPC-H