Results 1 to 5 of 5

11602 with dx 238.2 /173.9 ???

  1. #1
    Question 11602 with dx 238.2 /173.9 ???
    Medical Coding Books
    I have a provider that has submitted a 11602 with dx 173.9.

    However, The path report states Keratoacanthoma dx 238.2. (Uncertain Behavior) The Path does NOT confirm a Malignancy but the provider has coded it as malignant. dx 173.9 and does not want to change it to 11402 Benign.

    The patient does have a personal hx of Skin ca V10.83, which he did not include on the encounter.

    Is this correct coding? I have always been instructed if the Path report does NOT confirm a malignany, you should bill this as Benign (11402) and list the 238.2 as the dx.

    I can not find any documentation guidelines on this to prove this to the provider. Please help asap !!

    Thank you

  2. #2
    Location
    Jacksonville Beach, FL
    Posts
    71
    Default
    I think you should use the diagnosis that is on the pathology report, of course you will need to change your procedure code as well. I have surgeons that say they are using the Malignancy code before they get the path report back and I have to change the procedure code once we get the report.

    Just my opinion.
    AWest

  3. #3
    Location
    Columbia, MO
    Posts
    12,531
    Default
    When you have uncertain behavior pathology the CPT code then depends on the size of the margins. If thew provider excised the lesion with wide margins then you code with malignant excision, if he excised with narrow margins then you code with benign excision. Either way you use the 238.2 dx code. This is from an older CPT assistant.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Smile 11602
    Thank you for your reply ....Can you tell me what size distinguishes Wide vs Narrow Excisions? This was a 1.5 cm excision.

    I was always lead to believe the path report is what determines the benign or malignancy
    CPT code to be billed. That is the main reason we wait on the path report

    If you know what month/yr this information came from CPT assistant I would be eternally grateful
    Or can shed any other information on this
    Thank you!

  5. #5
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Quote Originally Posted by Dolores McKenzie View Post
    Thank you for your reply ....Can you tell me what size distinguishes Wide vs Narrow Excisions? This was a 1.5 cm excision.

    I was always lead to believe the path report is what determines the benign or malignancy
    CPT code to be billed. That is the main reason we wait on the path report

    If you know what month/yr this information came from CPT assistant I would be eternally grateful
    Or can shed any other information on this
    Thank you!
    You will have to know the size of the lesion and the size of the excision to know if it was wide or narrow. The path report does determine the CPT code however uncertain behavior sits on the fence, that is why then the size of the margins determines then the CPT code. I do not remember the CPT assistant this was from but it would have been somewhere around 2000 to 2001, I am sorry I cannot be more specific but it was some time ago.

    Debra A. Mitchell, MSPH, CPC-H

Similar Threads

  1. Bundling issues 11602 w/ 99213
    By tholcomb in forum Dermatology
    Replies: 2
    Last Post: 05-10-2013, 09:57 AM
  2. 173.4 new code?
    By ajijon in forum Diagnosis Coding
    Replies: 4
    Last Post: 01-28-2013, 11:05 AM
  3. ICD-9 Neoplasm Code Updates (173.xx)
    By MaryG215 in forum Diagnosis Coding
    Replies: 1
    Last Post: 10-17-2011, 02:59 PM
  4. 239.2 vs 238.2
    By Beth Coccia in forum Dermatology
    Replies: 19
    Last Post: 06-27-2011, 12:01 PM
  5. CPT 11602 coding help!
    By CoderinJax in forum Dermatology
    Replies: 0
    Last Post: 02-03-2011, 10:32 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.