You do not know nor does the physician l=know when a lesion is "obviously" cancerous, they can suspect it but they do not know it. It can have an appearance consistent with a malignancy but that again is not the same thing. A neoplasm (cancer) of the skin cannot be known or coded without a path report. If the provider is doing the excision to determine the morphology then the claim must be held until the path report is obtained. If this is a re-excision at the same site of a known basal cell due to positive margins then the path has already been rendered. You should never code nor change a code without the documentation. The diagnosis belongs to the patient, if this turns out to be nothing, you have already communicated a malignancy to the payer and have increased the patient's risk as a beneficiary.
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