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Neoplasm/ uncertain vs. unspecified

  1. #1
    Smile Neoplasm/ uncertain vs. unspecified
    Medical Coding Books
    could someone please explain to me the difference between uncertain behavior vs unspecified for neoplasm coding. I usually use uncertain, but is unspecified corrected if the path came back inconclusive
    thank you

  2. #2
    Columbia, MO
    uncertain behavior is a dx that is rendered by the pathologist when the cellular activity observed is uncertain at to its morphology. Unspecified is sometimes called a working dx, and is used when a preliminary diagnostic workup is inconclusive, most commonly used when the decision comes back as a tumor. You use the unspecified dx until further workup reveals the morphology of the anomoly. for instance when the physician states it is a tumor then we can know that the physician knows this is not a cyst or an abcess but is definitely neoplastic but yet to be specified by definitive workup as to benign or malignant.
    Hopefully this did not confuse you.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Bentonville, Arkansas
    if the path comes back inconclusive you may use the uncertain. Unspecified is just that, i.e. a puch biopsy charge that is billed before the path report comes back.

  4. #4
    Columbia, MO
    inconclusive is unspecified not uncertain.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    I would agree with Debra, "uncertain" behavior is a type of behavior that a pathologist dx, basically meaning that at this time they are not able to determine whether the behavior is malignant or not. With "unspecified" this means that the behavior is not stated by the pathologist.

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