Results 1 to 3 of 3

What diagnosis code - We did a biopsy on a Medicare patients

  1. #1
    Aberdeen, SD
    Default What diagnosis code - We did a biopsy on a Medicare patients
    Medical Coding Books
    We did a biopsy on a Medicare patients back, pathology came back with “dysplastic nevus fully evolved moderate cytologic and architectural atypia, extending to the lateral margins,” the pathologist used diagnosis code 216.5. The pathologist recommends a small conservative re-excision to prevent recurrence and morphologic progression.

    On a later date we performed the excision, should we use 238.2 OR 216.5 and V49.89. I am leaning towards 216.5 and V49.89. I am referring to the LCD policy L24361. Code 216.5 is a List II code, and I am wanting to use item D or E.

    List II. These ICD-9-CM codes identify those conditions for which payment is allowed only if the conditions have complications, consistent with the provisions noted above in Indications and Limitations of Coverage, items A through H. Providers are instructed that the addition of a second diagnosis code, V49.89 Other specified conditions influencing health status, is required and by using that code, providers will be asserting that their medical record documentation includes verification of the complicating sign, symptom or diagnosis that supports payment for the lesion removal.

    D. The clinical diagnosis is uncertain, particularly where malignancy is a realistic consideration based on lesional appearance (e.g. non-response to conventional treatment, or change in appearance). However, if the diagnosis is uncertain, either biopsy or removal may be more prudent than destruction.

    E. A prior biopsy suggests or is indicative of lesion malignancy.

    Whats diagnosis code would you use? Thanks for your help.

  2. #2
    Columbia, MO
    the path report is indicative of a 238.x code for uncertain behavior.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Aberdeen, SD
    The pathologist dx code sent me on the wrong track. Thank you

Similar Threads

  1. Code the scenario: Capture the primary diagnosis code only
    By Ally718 in forum Diagnosis Coding
    Replies: 1
    Last Post: 09-22-2015, 08:41 AM
  2. changing diagnosis code on claim when secondary denies the diagnosis code
    By in forum Billing/Reimbursement
    Replies: 3
    Last Post: 09-27-2013, 10:00 AM
  3. Diagnosis code for No Pathologic Diagnosis
    By benji1266 in forum Pathology & Clinical Laboratory
    Replies: 2
    Last Post: 09-02-2013, 07:00 AM
  4. To code or not to code: Mild (diagnosis)?
    By Jessheartz in forum Diagnosis Coding
    Replies: 1
    Last Post: 10-01-2012, 12:29 PM
  5. what to code: diagnosis vs diagnosis
    By mjl903 in forum Diagnosis Coding
    Replies: 6
    Last Post: 06-23-2011, 11:12 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.