# diagnosis for benign excision



## herrera4 (Mar 24, 2011)

dr dictates cyst which has recently grown bigger-he excised it-and comes back lipoma. Per medicare guidelines 2 diagnosis codes are needed for benign lesions (706.2 , 709.9, and 214.1 are all on the primary diagnosis list) what Dx could be used for secondary to prove medical neccessity for benign lesion on skin? ( recent enlargement?)

And, what would need to be dictated to code for to code out 682.xx? 

Thanks for any help in advance


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## mitchellde (Mar 24, 2011)

Where have you read this about Medicare requiring 2 dx for benign lesions?  I have billed lesions to Medicare for years and only used the one for benign when that is what the path report states with no problem.  If you truely must have 2 then go with V71.1 first listed and the benign dx secondary


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## coppercent (Mar 24, 2011)

*if Dr knew it was benign, why send to path?*

Diagnosis should be 239.2, neoplasm unspecified.  No Dr can be sure before the surgery that an enlarging lesion is benign, that's why they excise it and send it to path!  Dx 239.2 doesn't require a second dx for coverage.  The only time benign neoplasm should be used is if a biopsy was done on it and it came back benign, then you need a second dx as to why it's medically necessary to remove the rest of the benign lesion.  Makes sense if you think about it.


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## magnolia1 (Mar 24, 2011)

Thanks Deb........I was about to ask that same question.

I also code many Medicare claims for benign lesion excision, and have never heard anything from the billing dept regarding denials or reimbursement issues because I have only coded one diagnosis code for the lesion.


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## mitchellde (Mar 24, 2011)

coppercent said:


> Diagnosis should be 239.2, neoplasm unspecified.  No Dr can be sure before the surgery that an enlarging lesion is benign, that's why they excise it and send it to path!  Dx 239.2 doesn't require a second dx for coverage.  The only time benign neoplasm should be used is if a biopsy was done on it and it came back benign, then you need a second dx as to why it's medically necessary to remove the rest of the benign lesion.  Makes sense if you think about it.



239.x dx codes are working diagnosis that can be used after a preliminary diagnostic study shows a tumor of some kind which has yet to tbe determined.  Excisions cannot be coded without a path report.  prior to excision it is a skin disorder 709.x.  The original poster stated it was a lipma which is a pathologic dx rendered after study so I assumed a path report was back.


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## herrera4 (Mar 24, 2011)

this was an updated LCD for CT 

http://www.cms.gov/medicare-coverag...,+MAC+-+Part+B)&LCntrctr=180&bc=BAAEAAEAAAAA&

There is only a few codes listed as "payable"  secondary but it does say :

There may be instances in which the removal of benign seborrheic keratoses, sebaceous cysts, skin tags, moles (nevi), acquired hyperkeratosis (keratoderma), molluscum contagiosum, milia and viral warts is medically appropriate. Medicare will, therefore, consider their removal as medically necessary, and not cosmetic, if one or more of the following conditions are presented and clearly documented in the medical record:


Bleeding;

Intense itching; 

Pain;

Change in physical appearance (reddening or pigmentary change);

*Recent enlargement;*
Increase in the number of lesions;

Physical evidence of inflammation or infection, e.g., purulence, oozing, edema, erythema, etc.;

Lesion obstructs an orifice;


This was coded off the path report but denied for not medically neccessary-Thanks again


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## mitchellde (Mar 24, 2011)

So if the physician removed the lesion due to suspician for malignancy then use the V71.1 first listed.  This LCD does not stated you must have 2 diagnosis codes they just want to be certain it was not removed for cosmetic reasons.  That is why at the cancer center we routinely used the V71.1 first listed and it was always paid.  But to be clear it is not required that you have 2 diagnosis codes to bill a benign lesion.


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## herrera4 (Mar 24, 2011)

so looking through the Dr. dictation he does not state he thinks this could malignant but it is bothersome to pt and increasing in size-the path reports 214.1 which is listed under :

'For the conditions below, a Primary ICD-9-CM code AND a Secondary ICD-9-CM code that represents a complication are required:'

do you have any suggestions on a secondary Dx to show its not just cosmetic? Thanks for helping


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