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Excision of lesion CPT coding

  1. #11
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    I double dog dare you to say that to your physicians Deb.

  2. #12
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    Also the difference in benign and malignant is not that one is cancer and the other is not. they are in fact all neoplasms (cancer). the difference in benign and malignant is that a benign neoplasm has cells that stay within the boundarys of the anomaly whereas with malignant the cells multiply and spread out (simple explanation), Again the physician on visual inspection cannot know what type of cell(s) are within the "lesion"

    Debra A. Mitchell, MSPH, CPC-H

  3. #13
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    Quote Originally Posted by Oceanlivin View Post

    I double dog dare you to say that to your physicians Deb.
    I already have many times, and they agree with me every time!

    Debra A. Mitchell, MSPH, CPC-H

  4. #14
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    We are not discussing cancers Deb. We are discussing lesions.

    Scar tissue is a benign lesion.
    I am sure physicians can recognize a scar by sight.
    Last edited by Peter Davidyock; 11-13-2011 at 09:13 AM.

  5. #15
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    no scar tissue is not a benign lesion, it is a scar, the AMA has instructed that if a scar is excised out we are to code it using benign excision codes. we do not use a dx code for benign when coding a scar and it is usually described as keloid or just scar which has its own code and is not a benign neoplasm. so you may not use a 216.x code for a scar.

    Debra A. Mitchell, MSPH, CPC-H

  6. #16
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    By definition a scar is a lesion.
    Lesion: any structural change in a body part as a result of injury or disease.
    Scar: dense fibrous tissue that forms (that indicates structural change) over a healed wound.
    A Ghon Focus is a scar signature on a lung x-ray of an adult left by tuberculosis in childhood.
    A Ghon Focus "is" a lesion of the lung by definition and is readily identifiable by sight. In this case looking at the xray.
    You are missing my point Deb.
    CCMongillo everything you need to know to answer your question can be found in the definition of a benign lesion.
    Last edited by Peter Davidyock; 11-13-2011 at 09:54 AM.

  7. #17
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    My reasoning for posting to the forum is not the difference from benign or malignant dx of a lesion.....I leave this up to the MD and or Pathology. My question is as a coder placing a cpt do we choose from the opinion of the MD at the time of the excision or do we wait for the pathology with definitive tissue diagnosis of the lesion? Sometimes this can be different when the physician only states lesion or mass and the pathology of the lesion defines pre cancerous cells or a definite cancer.

  8. #18
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    Quote Originally Posted by Oceanlivin View Post
    By definition a scar is a lesion.
    Lesion: any structural change in a body part as a result of injury or disease.
    Scar: dense fibrous tissue that forms (that indicates structural change) over a healed wound.
    A Ghon Focus is a scar signature on a lung x-ray of an adult left by tuberculosis in childhood.
    A Ghon Focus "is" a lesion of the lung by definition and is readily identifiable by sight. In this case looking at the xray.
    You are missing my point Deb.
    CCMongillo everything you need to know to answer your question can be found in the definition of a benign lesion.
    I am not missing the point but you are arguing from different issues at the same time. I am speaking of skin lesions in particular in that the skin lesion may not be defined as benign or malignant without path and the excision may not be coded without path. A scar of the skin is not a benign lesion either and as I stated it has its own code we cannot decide to use a benign lesion code. As far as a lung scar going to benign neoplasm of the lung without benefit of path this too cannot be done. Bottom line is if the provider does not document it we cannot code regardless. You may not take an xray documented as lung scarring and code a benign lesion of the lung. And Neoplasm is another term for cancer, when you want to code a lesion benign then you are coding it as a benign neoplasm which is cancer non malignant.
    A ghon focus is not coded as a benign neoplasm of the lung that is my point. while scars are benign as to cells and morphology if you will they are not benign neoplasms.
    CCMongillo- You cannot code a mass or lesion as either benign not malignant, in this case you can code the mass or wait for path, for a skin excision you are required to wait for the path. so skin aside for any other surgery if you do not wait for the path then you may code the surgery and submit with the code of why the surgery was performed, meaning a mass or abnormality, you may not however make a quantum leap as to what the path may show and code either benign or malignant.

    Debra A. Mitchell, MSPH, CPC-H

  9. #19
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    It's all good Deb.
    My point is (was in the beginning) that a lesion can certainly be coded as benign.
    A benign skin lesion is "NOT" cancer.
    I am sorry to keep returning to the same way to qualify what I say but:
    Cancer: A "MALIGNANT" and invasive growth or tumor.

    Something classified as benign is not a cancer just because it happens to say benign.
    And in so much as misdirection goes I do not recall saying anything about coding Ghons'.
    My example was used to establish the fact that physicians can most certainly identify lesions by site characteristics.

  10. #20
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    i sill disagree when you are coding benign lesion you are code a cancer that is by morphology benign which is determined by path. You cannot code a lesion as a benign neoplasm.

    Debra A. Mitchell, MSPH, CPC-H

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