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New LCD from NGS for Lesion Removals

  1. #11
    Default NGS and Lesion Removals
    Medical Coding Books
    NGS plans to rescind the LCD advice about lesion excisions. Read the attached link article. It also states that on CMS Web Site "superceded" is written in red across the lesion excision LCD

    Heather Winters, CPC, CFPC

  2. #12
    Columbia, MO
    I spoke with John Verhoveshek at the AAPC a couple of weeks ago and he confirmed that it had been rescinded.. I put a post on this, I forget which heading I put it under. I should have attached one here too, Thanks Heather for passing the info along. He said the AAPC was instrumental in having this rescinded.
    Debra Mitchell, MSPH, CPC-H

  3. #13
    However, now I have received the following from NGS stating that pathology does not change procedure performed. Tell me, if we do not have a pathology report, how do we know if lesion was benign or malignant and which codes to select??
    Subject: Part B News: Medicare Providers Who Bill for Removal of Lesions (Article Revision)

    Revised Coding Information for Removal of Benign Skin Lesions

    This article replaces the Listserv article distributed on April 13, 2009. These instructions apply to providers who submit Part B claims. Additional guidelines applicable to Part A claims will be provided in a separate notice.

    Recent medical review of documentation has indicated an educational need with regards to the reporting of removal of lesions. The local coverage determination (LCD) and coding article (SIA) for Removal of Benign Skin Lesions (L27362/A47397) will be revised on June 1, 2009 and will include revised guidelines.

    If a benign skin lesion excision was performed, report the applicable CPT code, even if final pathology demonstrates a malignant or carcinoma in situ diagnosis for the lesion removed. The final pathology does not change the CPT code of the procedure performed. An ambiguous but low suspicion lesion would be reported as a benign lesion (codes 11400-11446) reflecting the procedure that was performed. A moderate-to-high suspicion lesion may be reported as a malignancy (codes 11600-11646), if the appropriate excision was performed.

    To report removal of lesions of uncertain morphology, prior to identification of the specimen, report ICD-9-CM code 239.2 (neoplasms of unspecified nature, bone, soft tissue, and skin), or ICD-9-CM code 709.9 (unspecified disorder of skin and subcutaneous tissue) since proper coding requires the highest level of diagnosis known at the time the procedure was performed.” (ICD-9-CM code 709.9 will be added to the list of payable diagnoses in the LCD.)

    Providers who submit claims to Medicare for excision of lesions should become familiar with the revised LCD which became effective March 1, 2009 and with future revisions.

    Thank you,

    National Government Services, Inc.

    Corporate Communications

    Did you recieve this directly or did you find this somewhere's ?

  4. #14
    Deb, is this the information you told me about last week (re: LCD and disagreeing with it) somewhere in another post? I have forwarded it to my supervisors as I agree with you and I was VERY uncomfortable changing our way of doing things and coding something before we even knew what it was. Unfortunately, our supervisors don't always have our back so I just go with "I am not comfortable putting my name on that" and pass it off to another coder who is willing to it. Not the best practice, I know, but at least it covers me and my integrity.

    Heather, thanks for the update and the link!

  5. #15
    Columbia, MO
    Yes this is the one and there is one after this one which has effective date of June 5th I think wich basically rescinds this one. Mr. Verhovechek agreed with me in that this is very poorly worded and goes against the grain of everything we have been taught.

  6. #16
    Default Ngs
    NGS is still showing the LCD with this wording as active
    Heather Winters, CPC, CFPC

  7. #17
    Which states does this apply to ?

  8. #18
    Columbia, MO
    I know it still shows as active they do not usually do not erase or obliterate the old ones which is unfortunate.

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