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Thread: ICD-9 Help / Dysplastic Nevus Back

  1. #11
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    AAPC: CPC Promo
    Quote Originally Posted by ambernewcomb View Post
    If the Dr is coding the procedure as a biopsy (11100) then you would not know what the diagnosis was and you would use 238.2 as your diagnosis code.

    If you are coding it with the excision codes 11400 - 11406 then you would use the 216.5 diagnosis code.

    If it turns out to be malignant then you would use the excision codes 11600-11606 and the diagnosis code would be 173.5 for Basal cell carcinoma and Squamous cell carcinoma, and 172.5 for Melanoma, if it is malignant in situ then the diagnosis would be 232.5

    You don't code the excision codes until you have the diagnosis, they will not pay for the unknown diagnosis code 238.2.

    Often my dermatologists will code the biopsy code for the original surgery and then when they do the reexcision to remove the rest of the lesion they will code with the excision codes and by then we already know the diagnosis code and do not have to hold the claim while we wait for path.

    Hope this helps,

    Amber L. Newcomb
    CPC
    Dermatology
    Again 238.x codes are not to be used until you have a path report that states uncertain behavior. The dx code is not for uncertain as to morphology, they are for uncertain BEHAVIOR morphology. You do not use this dx code for a biopsy, unless you have waited for the path and that is the result, you can use a 709.x code for the biopsy. If your physician does a full thickness removal of the entire visible lesion then it is not a biopsy it is an excision. If path shows positive margins then you may code for the re-excision when the physician performs that and you do already have the path report.

    Debra A. Mitchell, MSPH, CPC-H

  2. #12

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    When coding an excision, always wait for the pathology report otherwise how would you know whether to use a benign excision code or a malignant excision code.

    283.2 falls into a catagory of neoplasms which have already been microscopically reviewed and are still uncertain.

  3. #13

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    I agree with Mitchellede in her saying "The dx code is not for uncertain as to morphology, they are for uncertain BEHAVIOR with its morphology". Even there are many schools of thoughts and controversies about its behavior between Clinicians and Pathologist.
    I would like to state that
    morphology does not always predict biological behavior any more than a biopsy
    will always give a diagnosis.
    In my openion, the clinician is obliged to re-excise, and explain to the patient that
    microscopically it has features that appears to be "pre-malignant or starting
    to become malignant" and that the site should be re-excised for maximum
    safety.

    There are degrees of
    "benign", i.e. mild-to moderate-to-severe cytologic atypia, and that we
    should re-excise moderate to severe atypia with adequate margins. Its clear from this discussion that all this stuff
    about mild, moderate, and severe cellular atypia and mild, moderate,
    severe architectural atypia doesn't
    amount to anything except to detract from communication of whether
    something is benign, malignant, or "unsure". The responses as to what all of us are doing re: "nevi w/ architectural
    disorder and 1)mild 2)moderate 3) severe melanocytice atypia has been
    interesting, but since this is a relatively new categorization of nevi.
    Are there "benign"melanomas, an addition to the spectrum of benign PL, dysplastic PL, MIS,
    SSM, nodular MM, Met. MM? I do not know any answers to these issues but
    they are certainly very important questions. It is unclear if future molecular diagnostics will help or obfuscate the answers.
    As for us for our discussion, the "dysplasia' is a condition just a step away of the carsinoma in situ and its biological behavior is unpredictable .This is the bottom line of the interpretation of the all these terminology and let us leave the debate to doctors with unbiosed openion about its future behavior which is not in our hands especially unpredictable types of this dysplastic nature
    Last edited by preserene; 08-17-2010 at 11:21 PM.

  4. #14

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    239.2 can be a better code to use if you are billing for the biopsy prior to the pathology.
    When its an excision, always wait for the pathology before billing.

    In response to the comment of rule out codes...you can code a "rule out" diagnosis ONLY in an INPATIENT SETTING.

  5. #15
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    Quote Originally Posted by mfloit View Post
    239.2 can be a better code to use if you are billing for the biopsy prior to the pathology.
    When its an excision, always wait for the pathology before billing.

    In response to the comment of rule out codes...you can code a "rule out" diagnosis ONLY in an INPATIENT SETTING.
    Only if you are the inpatient facility coder not the physician coder.

    Debra A. Mitchell, MSPH, CPC-H

  6. #16
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    i realize that this is an old post but when i see or hear a statment like "insurance wont pay for xxx.xx dx so we use xxx.xx", the compliance auditor in me is immediately activated and i cannot let this slip by without saying that if you are following that theory, you are putting the organization that you work for at a huge liability risk should you ever get audited. You should never code to get something paid - you code the service as it is.

    Secondly, i'm not really sure why anyone is contemplating the use of 238.x. If you look up nevus in the tabular, it distinctly says neoplasm/skin/benign, which doesnt crosswalk to 238.x

    And lastly, i want to echo Debra's response regarding coding a rule out for inpatient facility coders only. Just because a patient is inpatient doesnt mean you can code rule outs for professional fees.

    i hope some of the comments in this posting are simple misspeaks.
    Dawnelle Beall, CPC, CPMA, CPC-I
    Licensed AAPC PMCC Instructor
    AAPC ICD-10CM Certified Trainer

  7. #17

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    You don't code the biopsy (11100) as a 238.2... you would wait for the biopsy results to come back and use the definitive diagnosis for everything that is ever sent off to a lab.

  8. #18
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    Default Derm

    Thank you for sharing.. Great explanation!

  9. #19

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    From CPT Assistant August 2000, pages 5-6:

    When the morphology of a lesion is ambiguous, choosing the correct CPT procedure code relates to the manner in which the lesion was approached rather than the final pathological diagnosis, since the CPT code should reflect the knowledge, skill, time, and effort that the physician invested in the excision of the lesion.

    Therefore, an ambiguous but low suspicion lesion might be excised with minimal surrounding grossly normal skin/soft tissue margins, as for a benign lesion (codes 11400-11446), whereas an ambiguous but moderate-to-high suspicion lesion would be excised with moderate to wide surrounding grossly normal skin/soft tissue margins, as for a malignant lesion (codes 11600-11646).

    (I know that was 14 years ago, but I am not aware of any changes since then.)

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