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Lesion Help!

  1. #1
    Default Lesion Help!
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    I would like some feed back on coding Lesions. I only receive "Lesion" on the out patient requisition that comes with the speciman. I have been told to use a Neoplasm code and others have told me not to. HELP! Thank you

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default What are you coding, and for whom?
    So you're getting a specimen and a requisition form that just says "lesion." Is that correct?

    For whom are you coding? What are you trying to code?

    Yes, you would use the neoplasm table and you would always be in the UNSPECIFIED column unless you have a specific diagnosis from pathology that told you what the lesion was. But even here you have at at least have the body area from which the lesion was excised.

    You write about receiving the specimen, so it sounds as if you are coding for a pathologist or lab. I'm just having a hard time envisioning a situation where you would be coding anything before the pathologist renders an opinion. At that stage you'd have a definitive diagnosis to use, and this shouldn't be such an issue.

    But maybe I'm not understanding your situation.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by pennysueorr View Post
    I would like some feed back on coding Lesions. I only receive "Lesion" on the out patient requisition that comes with the speciman. I have been told to use a Neoplasm code and others have told me not to. HELP! Thank you

    IMO, you should not use the neoplasm table to select a code for a lesion. There is a heading for "lesion" in the alphabetic index (section 1) of the ICD9 book. Look for the site and then check the numerical section for exclusion or inclusions.

    The only exception I would make for this is if the "lesion" is also described as neoplastic.

    I do agree that waiting for the pathology report would be the optimal solution to the question of the nature of the lesion.

    HTH
    Danny L. Peoples
    CIRCC,CPC

  4. #4
    Default
    I am coding for a laboratory and we perform the technical component, so I do not have a pathology report to code from as we do not receive them

  5. #5
    Location
    Columbia, MO
    Posts
    12,558
    Default
    I agree with not using the neoplsm table, if you do not have anything else then it is 709.8 or 709.9, however I agree you really should hold the claim and request a path report for the dx.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    Location
    Albany, New York
    Posts
    456
    Default
    Refer to CPT Assistant below:

    Laboratory-billing
    Coding Clinic, First Quarter 2000 Page: 3 Effective with discharges:
    April 1, 2000

    Question:

    A skin lesion of the cheek is surgically removed and submitted to the pathologist for analysis. The surgeon writes on the pathology order, "skin lesion." The pathology report comes back with the diagnosis of "basal cell carcinoma." A laboratory-billing consultant is recommending that the ordering physician's diagnosis be reported instead of the final diagnosis obtained by the pathologist. Also, an insurance carrier is also suggesting this case be coded to "skin lesion" since the surgeon did not know the nature of the lesion at the time the tissue was sent to pathology. Which code should the pathologist use to report his claim?

    Answer:

    The pathologist is a physician and if a diagnosis is made it can be coded. It is appropriate for the pathologist to code what is known at the time of code assignment. For example, if the pathologist has made a diagnosis of basal cell carcinoma, assign code 173.3, Other malignant neoplasm of skin, skin of other and unspecified parts of face. If the pathologist had not come up with a definitive diagnosis, it would be appropriate to code the reason why the specimen was submitted, in this instance, the skin lesion of the cheek.




    © Copyright 1984-2009, American Hospital Association ("AHA"), Chicago, Illinois. Reproduced with permission. No portion of this publication may be copied without the express, written consent of AHA.
    Karen Maloney, CPC
    Data Quality Specialist

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