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Lesion removals-waiting for path rpt or no path rpts?

  1. Default Lesion removals-waiting for path rpt or no path rpts?
    Medical Coding Books
    My physicians are having a problem deciding if they are to wait for the pathology report to come back before reporting an excision code as benign or malignant. I have researched this but have not found a for sure answer. I have read we can code either way, waiting for the path or just code benign. Does anyone know the answer to this and where I can find it in writing? Thanks for any help!!

  2. #2
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    Tacoma, WA
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    Quote Originally Posted by cat94 View Post
    My physicians are having a problem deciding if they are to wait for the pathology report to come back before reporting an excision code as benign or malignant. I have researched this but have not found a for sure answer. I have read we can code either way, waiting for the path or just code benign. Does anyone know the answer to this and where I can find it in writing? Thanks for any help!!
    If there is any question as to the diagnosis, it is always better to wait for the pathology. You do not want to mistakenly give a patient a malignancy that doesn't exist, or on the other hand report a malignancy as benign. The only thing in writing I could find is in the ICD-9 Official Guidelines for Chapter 2:
    "To properly code a neoplasm it is necessary to determine from the record if the neoplasm is benign, in-situ, malignant, or of uncertain histologic behavior. If malignant, any secondary (metatastic) sites should also be determined."
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. #3
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    Concord, NC or Rochester, NY
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    I would absolutely wait for the path report. A malignant code generally pays higher than a benign one so why would you want to bill and leave money on the table.

    Secondly, without the path report, you have to code benign as you cannot give a patient a dx they do not have.

  4. #4
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    Medicare will deny some procedures altogether if it is coded as benign...not medically necessary.

  5. #5
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    Columbia, MO
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    Quote Originally Posted by mdoyle53 View Post
    I would absolutely wait for the path report. A malignant code generally pays higher than a benign one so why would you want to bill and leave money on the table.

    Secondly, without the path report, you have to code benign as you cannot give a patient a dx they do not have.
    even if you code benign you are giving the patient a diagnosis not yet rendered by the provider. You cannot code a diagnosis not documented and without the path report for the excision you have no diagnosis beyond skin disorder. In addition the excision CPT codes are available in benign and malignant varieties only and you the coder cannot guess and cannot assume something not s=documented. No matter haow you cut it for an excision you wait for the path report. You cannot use 238.x codes either as this a diagnosis rendered by path. There is an old CPT assistant that states this, it is from probably around 1999 or the year 2000-

    Debra A. Mitchell, MSPH, CPC-H

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