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Excision of Uncertain Behavior Lesion

  1. Default Excision of Uncertain Behavior Lesion
    Medical Coding Books
    If the pathology comes back as "Keratoacanthoma" uncertain behavior........should the benign excision codes be used?

  2. #2
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    Milwaukee WI
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    Default 238.2 is NOT classified as malignant
    Since ICD-9 238.2 (Keratocanthoma, unspecified behavior) is NOT classified in the Neoplasm table as Malignant, I would use the benign excision codes.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3
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    Columbia, MO
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    There was a CPT assistant some time back that covered this and it stated that if the path comes back as uncertain then we go back to the details of the excision to figure out the CPT code. If the excision had narrow margins or is documented as a scar sparing technique then we code it as benign CPT, if the margins are wide or documentation states a wide excision then we code it as malignant CPT.

    Debra A. Mitchell, MSPH, CPC-H

  4. Default
    You choose benign excision vs. malignant excision according to diagnosis, not margin size. Benign excision would be correct, unless the Pathologist indicated evidence if squamous cell carcinoma or scc in situ, then you would bill malignant excision.

  5. Default
    Quote Originally Posted by jmastel View Post
    You choose benign excision vs. malignant excision according to diagnosis, not margin size. Benign excision would be correct, unless the Pathologist indicated evidence if squamous cell carcinoma or scc in situ, then you would bill malignant excision.
    Thus true and if the the result does not say malignant then thus benign.
    XS

    sauka

  6. #6
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    Columbia, MO
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    Quote Originally Posted by jmastel View Post
    You choose benign excision vs. malignant excision according to diagnosis, not margin size. Benign excision would be correct, unless the Pathologist indicated evidence if squamous cell carcinoma or scc in situ, then you would bill malignant excision.
    That goes contradictory to the AMA instruction, But what they say makes sense, if the provider feels the result will likely be benign then he creates a smaller scar, therefore smaller margins, if the provider fears the result is likely malignant then he will take large margins in an effort to avoid a re-excision due to positive margins. Uncertain behavior is cellular activity cannot be classified as either benign or malignant so the only thing you have to go by is the intent of the provider which is evident by the margin size. If you have an official source to support your instruction I would like for you to post it so that it can be accessed.

    Debra A. Mitchell, MSPH, CPC-H

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