# Coding destruction of lesion, questionable malignancy



## ca_cpc (Feb 16, 2015)

One of my providers (I work in primary care) sent through a billing form indicating that she performed cryotherapy on a SCC of the right ear. However, on reviewing her actual note, I'm not confident that I should be coding for malignancy. The pertinent note is as follows:

"possibly AK but with partial healing/bleeding cycle likely SCC
Discussed pathophysiology, possible treatments(including risks and benefits) 
discussed bx only way to know
discussed risks and benefits of cryotherapy (infection, regrowth and needing bx/excision)
Procedure verbal consent, cryotherapy to area x3 with 20-30 thaw between freezing, pt tolerated well"

My first instinct on the SCC destruction, since it was documented as such on the billing form as well as added to the problem list as a diagnosis, was to use CPT-17280. However, with her apparent indecision between an AK and a SCC per the procedure note I feel like I should use CPT-17110 with ICD-709.9. Can I get a second opinion on this?

Thank you,
Christie Anna


----------



## JesseL (Feb 16, 2015)

I think the "bleeding" part may support that it's most likely an SCC.  I would go with malignant destruction and 239.2 since the provider wasn't sure what it is BUT approached the treatment as if it were malignant.  That's just my opinion.


----------



## mitchellde (Feb 16, 2015)

you cannot code uncertainty for physician claims at any time.  Read the note in the book for using 239 codes.  It states the term "Mass" is not to be regarded as a neoplastic process.  Written in quotes mass means any other similar terms such as lesion.  In the book key word lesion then skin takes you to the 709.9 code and that is the correct code, I would ue the 17110 destruction.  Be prepared for this to be denied for cosmetic reasons.  without a path report this will be hard to successfully appeal.


----------



## teresabug (Feb 16, 2015)

exactly... without a path report, the doctor does not truly know what the lesion is/was. You would bill the destruction code.


----------



## JesseL (Feb 16, 2015)

mitchellde said:


> you cannot code uncertainty for physician claims at any time.  Read the note in the book for using 239 codes.  It states the term "Mass" is not to be regarded as a neoplastic process.  Written in quotes mass means any other similar terms such as lesion.  In the book key word lesion then skin takes you to the 709.9 code and that is the correct code, I would ue the 17110 destruction.  Be prepared for this to be denied for cosmetic reasons.  without a path report this will be hard to successfully appeal.



Does that mean without the support of pathology, we can never code a malignant destruction?


----------



## mitchellde (Feb 16, 2015)

Correct!


----------



## JesseL (Feb 16, 2015)

Even if the provider is 99% sure just from looking at it?  I thought sometimes the provider can identify a lesion without sending it to pathology?


----------



## mitchellde (Feb 16, 2015)

No they cannot tell by looking what the cellular activity consists of.  To know if an anomaly is benign or malignant they need a path report.  Being 99% sure is not code able as it is still uncertain. 100% sure is a path report for certain.


----------



## arrana (Feb 18, 2015)

If you hold the claim until the path report comes back, and the path report states malignant, can you then code for malignant destruction? Or do you have to go with what you knew at the time of service? I have a provider asking...

Thanks,
Arrana


----------



## mitchellde (Feb 18, 2015)

arrana said:


> If you hold the claim until the path report comes back, and the path report states malignant, can you then code for malignant destruction? Or do you have to go with what you knew at the time of service? I have a provider asking...
> 
> Thanks,
> Arrana



Yes if the specimen is submitted the same day as the destruction the you may wait for the result.  If the result is malignant then code malignant destruction.


----------

