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Shave removals sent for pathology

  1. Default Shave removals sent for pathology
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    Hi all,

    I read in last month's coding edge regarding the different types of removals Shave (11300-11313), Biopsy (11100, 11101) and Excisions (11400-11446),
    (11600-11646), (17260-17285)

    So what I got out of it was that if we are sending something for pathology you use the 11100, 11101, etc. codes.

    Can you really not use the 11300-11313 to bill for biopsy with a shave technique?

    If that's the case would it be fair to say, that you CAN bill a 11100 for a biopsy stating that it was done with a shave technique?


    I hope that I made sense,

    Thanks, dscoder74

  2. Default Help! Biopsy and removals :0)
    Hi all,

    I read in last month's coding edge regarding the different types of removals Shave (11300-11313), Biopsy (11100, 11101) and Excisions (11400-11446),
    (11600-11646), (17260-17285)

    So what I got out of it was that if we are sending something for pathology you use the 11100, 11101, etc. codes.

    Can you really not use the 11300-11313 to bill for biopsy with a shave technique?

    If that's the case would it be fair to say, that you CAN bill a 11100 for a biopsy stating that it was done with a shave technique?


    I hope that I made sense,

    Thanks, dscoder74

  3. #3
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    Columbia, MO
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    There are specific definitions for these removals,
    Excision- full thickness removal of the entire lesion
    shave - partial thickness removal of the entire lesion
    biopsy - removal of only a piece of the lesion
    we cannot interchange these definitions.
    An excision must be held until pathology is returned with the diagnosis
    Shaves and biopsy may be billed without the pathology but the diagnosis may not be neoplasm uncertain or neoplasm unspecified. Let me know if you need more information
    Debra Mitchell, MSPH, CPC-H

  4. #4
    Default
    Someone else posted a topic regarding this issue. There were two different articles printed in the coding edge, one was Jan 2009 and the other was April 2008. The first issue, which was a family practise, stated to use 11300 for a shave biopsy and the second was a dermatology and it says to use 11100. I sent a letter to the editor of the coding edge asking them to post another article to clear this up. My doctor states "Shave biopsy" on her procedure note and insist on me billing 11100. I am still a little confused on the subject so i can't say if it is correct or not.

  5. #5
    Default
    Quote Originally Posted by mitchellde View Post
    There are specific definitions for these removals,
    Excision- full thickness removal of the entire lesion
    shave - partial thickness removal of the entire lesion
    biopsy - removal of only a piece of the lesion
    we cannot interchange these definitions.
    An excision must be held until pathology is returned with the diagnosis
    Shaves and biopsy may be billed without the pathology but the diagnosis may not be neoplasm uncertain or neoplasm unspecified. Let me know if you need more information
    Debra Mitchell, MSPH, CPC-H
    I do the billing for the physician's at a hospital. Our dermat clinic is new to us and she came from private practise. She insist on coding her charges herself. We just overlook to make sure things are appropriate. For every biopsy she bills 11100 with dx 238.2. I was always taught to code the dx from a pathology but she doesn't want us to wait. I would say this dx is incorrect. How can you code neoplasm without a pathology report ? Would you agree with this ? Can you use that dx when you are in private practise ?

  6. #6
    Location
    Columbia, MO
    Posts
    12,570
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    No you may not use that dx without a path report. The CDC put that code in the code set to identify when the pathologist renders a dx after examination of the sample under a microscope, we cannot attach our own definition to these codes. If a biopsy is performed and she does not wish to wait for pathology then you can only use 709.8 as the dx. The diagnosis and the code for that dx belongs to the patient. If the diagnosis has not been pathologically determined to be of uncertain behavior then we cannot use that code. You could be affecting your patients with this dx in a bad way. The neoplsm unspecified implies that a preliminary diagnositic workup has been performed which reveals a dx of tumor, this can be coded then as neoplasm unspecified until more definitive procedures can determine the morphology.
    Also on the shave biopsy note, a biopsy can be either full or partial thickness, the key is whether the entire visible lesion was removed or only a piece of it. Those are AMA definitions.
    Debra Mitchell, MSPH, CPC-H

  7. #7
    Default
    I agree, her coder's from her private practise says they have always used that dx with 11100. I told them it was incorrect but they insist that is what she wants on her charges for the patients so i don't change it. Our coding department is in the middle of a pretend audit. We are pulling up old charges and letting a senior coder look over them as if we were in a real audit. I told them that these charges would be one of the error's.

    thanks

  8. Talking From Last Month's Coding Edge
    Shave Removal
    Dermal or epidermal lesion(s) shaving should be
    reported with codes 11300-11313. The shaving procedure
    is epidermal and dermal lesion(s) removal
    without a full thickness dermal excision by transverse
    incision or horizontal slicing. This tissue
    removal does not necessarily support a biopsy and
    should not be coded as a biopsy.
    Keep in mind, a shave removal is also not considered
    an excision. Excision codes should not be reported
    for this service.
    Lesion removal by shave technique is a superficial
    removal and does not always constitute entire lesion
    removal. The depth and location often determine if
    the entire lesion is removed by shaving. Often, shaving
    is only done to get the surface back to flat.
    Shave removal can be reported for benign or malignant
    lesions. The measurement of the actual lesion's
    location and size (not including any margins) is
    necessary for proper code selection. Closure is not
    necessary with shave removal. Local anesthetic and
    electrocautery of the wound is included.



    So my question is, can you use 11300-11313 codes to bill for a biopsy? I understand what is stated in this article. I want to know if other derm coders think this way?

    Thank you,

    dscoder74

    P.S. Thanks to all who have responded

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