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239.2 vs 238.2

  1. Smile 239.2 vs 238.2
    Medical Coding Books
    2 of my derm. docs. are ?ing using 238.2 or 239.2. ICD 9 states 239 "neoplasms of unspecified nature" category 239 classifies by site neoplasms of unspecified morphology and behavior. 238 states "neoplasm of uncertain behavior of other and unspecified sites and tissues. As far as reimbursement which one is the more approriate code to use?

  2. #2
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    I wait till pathology comes back then use the pathology diagnosis and 239.2 as sercondary. as it was unspecified when biopsy was done. This is also the way our dermatology academy tells us to code. Hope this is helpful.
    Tammy L. Coleman, CPC

  3. #3
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    If you wait for path then you code from the path you would not use the 239.2 code as well.
    239.x codes are referred to as a working dx. It is the code that can be used once a preliminary diagnostic study such as a CT scan renders a diagnosis of a tumor. This then is classified as a neoplastic process that needs further study to determine the morphology.
    the 238.x codes may be used after pathology renders the diagnosis of uncertain behavior.
    A biopsy is a removal of a piece of the visible anomoly and does not require pathology for claim submission but you cannot use a 238.x or 239.x code you need to code the skin disorder usually from the 709.x category.
    A shave is a removal of the entire visible anomoly but only to a depth of partial thickness which is into the dermis but not through it. You also do not have to wait for a path report but again not a 238.x or 239.x.
    An excision is a removal of the entire visible anomoly to a depth of full thickness which is through the dermis and to or into the subcutaneous layer. You must wait for the path report before the claimmay be coded and submitted.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
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    Per The Coding Institute's Dermatology Coding alert newsletter September 2010 Volume 6, no 9 It states you should wait for pathology and also states that 238.2 is used only when the pathologist is uncertain or the cells of the lesion are of mixed types. ICD -9 code 239.2 states neoplasm of unspecified nature, that is what the lesion is until I hear back from path. I do use the 709.x series if the pathologist states it is a skin disorder and not a neoplasm. I f path states neoplasm I use the 172.x maglignant neoplasm of skin based also on the skin location.
    Last edited by LadyT; 02-24-2011 at 11:47 AM.
    Tammy L. Coleman, CPC

  5. #5
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    I agree with the 238 it is as I stated above a diagnosis rendered by a pathologist. My infor mation for the 239 comes from AHA coding clinics. The physician examining the lesion is the one that documentes a skin disorder which is what you have until the pathe report states otherwise. A neoplasm can be either benign, malignant, or uncertain, that is the cell type which is why it must be rendered by a pathologist. I am not sure what you mean when you say the path states neoplasm you use a malignant code. the path should state malignant or benign or uncertain, and you will code accordingly.
    According to the AHA to use a 239 you must first have a preliminary study to show that all other posibilities have been ruled out such as a cyst or an abscess, so that what the provider now knows it that this is a new growth that has yet to be determined as to type, that is why they referr to it as a working dx. You are not allowed to assume that a lesion or a mass is a neoplastic process.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    Default 238 vs 239
    What would you use if the Doctor is not sure what the neoplasm is but is not doing a biopsy at this time? I thought that you use 239 before the biopsy and 238 after the biopsy if the biopsy still comes back as uncertain.

  7. #7
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    If he is examining a skin lesion the it comes under skin disorder which is a 709.x , if it is something he/she can feel say under the skin then it is a mass or a lump. As I stated per coding clinic a 239 is after a preliminary diagnositic returns a diagnosis of a tumor and a 238.x is when pathology reveals uncertain behavior as the diagnosis.

    Debra A. Mitchell, MSPH, CPC-H

  8. #8
    Default 238 vs 239
    Would I use the 709 code if the doctor is doing a biopsy at a different visit (1 week away)?

  9. #9
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    yes until pathology sates a different diagnosis

    Debra A. Mitchell, MSPH, CPC-H

  10. #10
    Smile 238 vs 239 vs 709
    That is great information! I will print this out for future reference. Thank you!!

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