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Thread: Benign vs Malignant CPT

  1. #1
    Join Date
    Apr 2007
    Kalamazoo MI

    Default Benign vs Malignant CPT

    AAPC: Back to School
    I've always been told when my provider does a excision I always code from the path report for dx for that DOS and CPT depending on size of excision (code outpt so most of my excisions are done in the office), unless marked skin biopsy. What about when the provider does an excision and comes back malignant and the doctor decides to do a WLE at a later date and that path comes back as benign. Would you then use the CPT code for benign or malignant.

    example: pt has excision done on lower back, I coded ICD-9 173.5 and CPT code used was 11602. Down the road the provider wants to do a WLE he wants to use the 11603 again even though the path report comes back as benign no residual malignant found. I would think to use CPT code 11403 and ICD 9 216.5 and V10.83.

    thanks for any help I can get.

  2. #2
    Join Date
    Apr 2007


    I would check the op report to see how deep the excision goes, you may want to look at 21930 if the excision goes deeper than the dermis and into the subcutaneous tissue. I think of it this way, he is doing a wide excision of a malignancy, (WLE?), so if the second excision comes back as benign it's because most or all of the malignancy was removed with the first excision, the second excision is to ensure the malignancy is totally excised with clear and adequate margins. He is still doing the procedure because of the malignancy. Does that make sense? Does anyone agree?

  3. #3


    I agree, that's they way we have been billing.

  4. #4

    Default Benign Vs Malignant CPT

    Just curious as to why code 21930 (If DX is 173.9)?
    and not the codes from the integ. section. CPT book states if still in post op period to append modifier 58.

    D.Hopp, CPC

  5. #5
    Join Date
    Apr 2007


    If you read my post I explain that if the excision is deeper than the dermis and into the sub-q tissue then 21930 would be a more appropriate code.

  6. #6

    Default Benign Vs Malignant

    Sorry Zina - I guess I didn't read your post correctly - I apologize
    Deb, CPC

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