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Excisional biopsies

  1. #1
    Greeley, Colorado
    Default Excisional biopsies
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    I have a doctor who documented "3 nevi back. 1% lido with epi anesth, #15 blade excision. Discussed wound care. Upper, mid and lower back specimens." He has coded 11402, 11401, 11400. Now aside from the fact that I obviously need to talk to him about modifiers, I also need to talk to him about DOCUMENTATION. Does anyone have a link for something in writing that I can show to this man? He is very arrogant, so I want to go in there with both guns loaded so to speak.
    Lisa Bledsoe, CPC, CPMA

  2. #2
    If the doctor excised the entire benign lesion from the patient, it is appropriate to bill the excision of lesion versus the biopsy code. A biopsy codes ar for when a part of a lesion is removed for pathology, where further action such as full excision will be considered in the future. A fullly excised lesion can also be sent to pathology for analysis so that it be determined if it is benign or malignant. Since you are referring to it as a nevi, I assume that pathology has already been done.

    Yes, doctor needs to be more specific in his documentation listing the size of his narrowest margins around the lesion so that you and he can determine the correct code. In teaching him, I and most of your fellow coders know your inclination to go in with guns loaded, but the gentler approach should work better, showing him the CPT manual, where it instructs how to code for lesions, telling him that you want to get him paid the most you can and with that documentation, should all three not get paid when the claim is submitted, you can't appeal and get him paid for all three with the documentation he provided you. If you get him to see it as a win win and it is about more money for him, he might put down his arrogance for a minute. Ask him, if he can come up with an idea in the context of these CPT rules, what can be done to give you to tools to make sure you can bring him in the most compliant money possible. That way, it will be his idea, not yours

  3. #3
    Greeley, Colorado
    Thank you. You have a valid point. I'll try ONE MORE TIME with this provider to approach him diplomatically. I like your suggestions.
    Lisa Bledsoe, CPC, CPMA

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