# New to Derm; HELP!



## reichtina320 (Jul 26, 2008)

Hi,  I am new to derm and doing an audit on some dermatology services.  I have a few questions I hope someone can answer for me.

Provider wanting to code OV (new patient) and 11100, 11101, 88305; the documentation does support the OV; but for the surgical codes I see nothing except the little written in the assessment & plan:  probable seb k under lt breast irritated, r/o bcc.  shave bx today.  probably skin tag pigmented vs melanoma, shave bx obtained today.

Then the r/o and the vs melanoma has been crossed through with a BA written next to it.

I have not read a lot of derm notes but to me this does not support the surgical procedures.

Help!  Am I off base here?

Thanks!


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## dmaec (Jul 27, 2008)

it's difficult to help without reading the complete note. Could you post the note? (without the name of course) 
from what you've written:
1) of course we can't code "rule outs" or "probables" - so go with lesion codes and signs/symptoms (irritated/inflamed)
2) I don't see codes for the shave removals - 11100-11101 are not shave removals. 
3) I don't see a size mentioned
4) I'd go with the lowest sized shave excision codes for the area's since no size was stated. 11300 for the shave excision under lt breast - No idea where the skin tag was that was shaved off but "where-ever" that code too.
5) was the patient going to the provider "just for" removal, was it a consult, a referral?
6) I'd code the removals ONLY before I coded an E/M only.
Of course this info comes from ONLY what you've written - ONLY what I've read  
my advice could change once you post the note!


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## reichtina320 (Jul 27, 2008)

Hi Donna,

That was the note!   Other than the information documented for the level of service his assessment and plan reads:

probable seb k under lt breast irritated, r/o bcc. shave bx today. probably skin tag pigmented vs melanoma, shave bx obtained today.

That's it!  I don't see anything in this note that supports coding the bx.  I'm thinking there should be something about size, injection of local anesth, etc....

Thanks


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## newellj (Jul 27, 2008)

*Shave Biopsy*

Shave Biopsy code is 11100, 11101. She mentioned that it was a biopsy not a removal. 
Hope this helps.


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## dmaec (Jul 28, 2008)

newellj - I could be wrong, but I believe acodingangel should still use "shaving of Epidermal or Dermal Lesions" codes - depending on the size & area.  At least that's the codes I'd choose after talking with the provider to get a bit more information on the actual procedures AND to have them amend their documentation to support their services.  The way I read the description/definition of the BIOPSY codes is: "During certain surgical procedures in the integumentary systme, such as excision, destruction or shave removals, the removed tissue is often sumitted for pathologic examination. The obtaining of tissue for pathology during the course of these procedures is a routine component of such procedures.  This obtaining of tissue is not considered a separate biopsy procedure and is not separately reported.  The use of a biopsy procedure code (eg, 11100, 11101) inditcates that the procedure to obtain tissue for pathologic examination was performed independently, or was unrelated or distinct from other procedures/services provided at that time. Such biopsies are not considered compenents of other procedures when performed on different lesions or different sites on the same date, and are to be reported separately.

and therefore, I'd use the shave removal codes.
but that's just me


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## dmaec (Jul 28, 2008)

hey acodingangel  
so what type of OV is it then? I mean, what level, what dx codes would you be using on the OV?
I think what I would do is query (hate that word)LOL) but query the provider to clear things up - tell them, you feel documentation does't support a procedure and that their documentation needs to be amended.  
I still feel the shave excision codes the ones you should be using for this.
I know others have different opinions  hopefully you get a few more suggestions from other coders that will help you in your decision.
but - that's my 3 pennies - query the provider - and use appropriate shave excision codes.


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## johnstond (Jul 28, 2008)

*Debbie-CPC*

I agree with CPT 11300 for shave removal of lesion, based on no description of size. I am also assuming the entire lesion was removed. Verify with provider. The dx would be for benign lesion by site unless you have a path report with a more specifice dx.  CPT 88305 would not be billed unless your provider is also a pathologist


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## reichtina320 (Jul 28, 2008)

Thanks for all the responses.  I was trying to clarify that such cryptic notes actually support the biopsies done.  In auditing this physician I am finding several notes that state shave bx done today or punch bx done today but...........nothing else about the biopsies.

So what should a bx note look like; what information should be included?  I'm thinking that it should at least give measurements and whether or not a local anesthestetic was used.............

Thanks


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