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skin lesion removal HELP!

  1. Question skin lesion removal HELP!
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    I have always coded removal of skin lesions from the path report as my doctors don't give measurements. I read the article in may's coding edge and from that I see this is ok to do. If I have a malignant dx from the path report I use the cpt code based on this. I have been told today that's incorrect. Can someone help me determine which is the correct way to code removal of skin lesions?

    Tracey

  2. #2
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    You are required to wait for the path report unless you are coding for the inpatient facility codes. What reason were you given when you were told you could not? And if the physician does not provide the measurements the only choice you have is the path report.

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    I got an email from someone that says the Don Self newsletter states that the final path report does not change your cpt code. It states that rules were changed on March 1st but I can't find anything on CMS stating this.

  4. #4
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    I see nothing anywhere that sugests this rule has changed , in order for that to happen we will need new CPT codes because now we cannot apply the correct CPT code unless we have a pth report, it would be ludicris to appen a malignant dx with a benign excision code and there is no excision code except benign or malignant at this time. Perhaps it was discussed at the March meeting of the minds and is a proposal for 2010. I did read where we are getting 140 new dx codes this year and many more changes to CPT, lets keep our ear to the ground but unless you see new CPT codes come down then we will have to get it off the path report.

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    I work in general surgery and my process is to wait for the path as well. Most of the time the doctor has an idea if it is going to come back malignant or benign. You need that path to code the procedure correctly! If you do not have size you should be going back to the doctor to dictate that in his chart note. If your clinic/hospital was ever audited there would be some issues for no supporting documentation. Hope that helps!

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    I always wait too for the path report then attach it with my op report to show where the measurements came from. I was just a little shocked when I heard that it's not ok to use the path report. This is what I have always done.

  7. #7
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    Which issue of Don Self did they get that from, I have read several and I have not seen this. This would have to come from the AMA to be official since they create the codes. I would continue to use the path report until you see something from them.

  8. #8
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    I just contacted Don and he was kind enough to allow me to share this....

    LESION EXCISION RULES CHANGED MARCH 1ST

    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.)

    If you would like the complete newletter, please PM me. I can send you the attachment.

    I believe this is the Medicare link he's referring to......

    http://www.ngsmedicare.com/ngsmedica...active_lcd.htm
    Last edited by RebeccaWoodward*; 05-22-2009 at 09:08 AM.

  9. #9
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    Thanks Rebecca I sent you a PM

  10. #10
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    Coding lesion removals before getting the path back doesn't make any sense at all and using a malignant dx code for a benign lesion removal seems totally ludicrous. I don't think the size of the lesion should ever be taken from the path report. The lesions shrink when put into formalin and are not always the same size as what the physician excised in the office. Our office has a lesion removal sheet so the physican can document the size of the lesion, the size of the margins and what type of closure was used. I believe this is the correct way to code lesion removals.
    Chrissy, CPC

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