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Excision of lesion CPT coding

  1. #1
    Default Excision of lesion CPT coding
    Medical Coding Books
    When choosing a cpt code for lesion removal do you wait for the pathology report to code benign or malignant lesion removal or do you code by what the MD is stating on his procedure note which may only be mass or lesion not stated as benign or malignant? Any input with reference is appreciated.

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    I was always advised that it is best to code off the pathology report for highest specificity and accuracy on lesions, since there aren't such a thing as "Not specified" lesion codes.

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    I was taught in my medical coding class earlier this year, that you always assume a lesion is benign, unless the pathology report states specifically that it is malignant. My coding teacher runs her own billing and coding service, is certified.

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    "... you always assume a lesion is benign, unless the pathology report states specifically that it is malignant."

    We never assume anything in coding...so we want a path report.


    Dee
    CPC, CPMA, CPCD
    Dee
    CPC, CPCO, CPMA, CPCD

  5. #5
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    Quote Originally Posted by juliabiz@hotmail.com View Post
    I was taught in my medical coding class earlier this year, that you always assume a lesion is benign, unless the pathology report states specifically that it is malignant. My coding teacher runs her own billing and coding service, is certified.
    I hate tto contradict your instructor but she is incorrect on this. First you cannot assume anything, second you cannot code what is not documented. The provider documents that an anomly is removed so you cannot code benign, in additon thisis the patient's diagnosis so we must code for the patient. Since the pathologist is a doctor we can code from the path report which is the patient's diagnosis. You must hold the claim for excision until the path is received.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
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    So what I am understanding is that if an MD states excision of mass or lesion on a procedure note and the path comes back as a cancer than a malignant lesion cpt is used or if op note states excision of mass or lesion and the path is a benign result a benign lesion cpt is used. It is confusiing to me if a cpt is choosen from the op note or from the definitive path result. Thanks for all of your input on this. Does anyone have a reference that they have confirmed this with?

  7. #7
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    Quote Originally Posted by CCMongillo View Post
    So what I am understanding is that if an MD states excision of mass or lesion on a procedure note and the path comes back as a cancer than a malignant lesion cpt is used or if op note states excision of mass or lesion and the path is a benign result a benign lesion cpt is used. It is confusiing to me if a cpt is choosen from the op note or from the definitive path result. Thanks for all of your input on this. Does anyone have a reference that they have confirmed this with?
    You are correct in what you state, that is for skin lesion excisions we wait for the path report. This is a decision the AMA made several years back and it is why you see excision codes in only benign or malignant choices, you are not allowed to guess and can only code known neoplasms. Please check out my article from the August coding edge about coding the correct diagnosis. Also if you look at the CPT assistants listed under the excisions in the CPT book one of them will have this information and it is an older one around the year 2000 or so.

    Debra A. Mitchell, MSPH, CPC-H

  8. #8
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    Most Physicians I know have the clinical acumen to define a benign lesion by site. If they suspect a malignancy (cancer caused lesion) they will perform a full thickness skin biopsy for path.
    A benign lesion is an anomoly caused by something other than cancer. Look up the definition. It's really no more complicated than that. Physicians will send benign lesion samples to path as well for safety's sake but if they are only noting "Lesion" 98 percent of the time they are referencing benign.
    I think the single biggest problem with coding these is the lack of understanding of what constitutes a benign condition.

  9. #9
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    I do not think they can define a benign lesion by site, they can suspect it because it has characteristics of benign but they have no way of knowing the cellular morphology. The CDC defines the codes of benign, malignant, and uncertain behavior as morphologic diagnosis based on microscopic examination of the cells. The physicians send the specimen for path to confirm a suspicion, and we cannot code suspicion. We cannot code benign because the provider states "lesion"

    Debra A. Mitchell, MSPH, CPC-H

  10. #10
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    Thanks Debra for your reply....I will try and locate the documentation that you are reffering to. I have been struggling with a conflict for I feel that within my CPC and CPC-H training and certification I have learned that you identify a lesion based on the path to benign or malignant and then choose the excision cpt code. The hospital outpatient department that I work within is making a cpt code choice of benign or malignant based solely on op note therefore sometimes coding malignant lesions to benign. They are basing their decision stating that you code cpt code at the time of procedure not path for this was not known at the time of excision. Hopefully I will be able to locate documentation to bring forward. Thanks again.... I appreciate the information and support of this forum.

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