# KERATOACANTHOMA excision, benign or maligant



## JesseL (Nov 7, 2014)

I have a path report that came back as KERATOACANTHOMA, it also stated "scc can not be ruled out"

Is this coded as malignant or benign excisions.

I find conflicting information on this.

The provider sent it to pathology thinking it could be either cyst or bcc so I think she had the intent to excise the whole thing, but the pathology came back showing that she did not obtain clear margins.


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## mitchellde (Nov 7, 2014)

JesseL said:


> I have a path report that came back as KERATOACANTHOMA, it also stated "scc can not be ruled out"
> 
> Is this coded as malignant or benign excisions.
> 
> ...



You can use V71.1 as the first listed dx, and the code for the finding as secondary.  You cannot code the scc as it was not found to be certain.


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## JesseL (Nov 7, 2014)

mitchellde said:


> You can use V71.1 as the first listed dx, and the code for the finding as secondary.  You cannot code the scc as it was not found to be certain.



do I code v71.1 with 238.2 along with the malignant excision code?

or do I use the benign excision code?


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## mitchellde (Nov 7, 2014)

JesseL said:


> do I code v71.1 with 238.2 along with the malignant excision code?
> 
> or do I use the benign excision code?



That is a good question.. An older CPT assistant stated that you code benign excision if the margins were narrow and malignant excision if the margins were wide.  We were told at the cancer center that unless the doctor documented "wide local excision" we were to consider it as benign exclusion when the path was uncertain.


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## JesseL (Nov 9, 2014)

I would think it's considered precancerous.. what would we do if an actinic keratosis was excised since that's precancerous?


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## mitchellde (Nov 9, 2014)

JesseL said:


> I would think it's considered precancerous.. what would we do if an actinic keratosis was excised since that's precancerous?



No a keratocanthoma is not precancerous it is uncertain behavior it is totally different.  The AK is coded as a benign excision as it's behavior is not uncertain it is definitive and is benign.  It is precancerous as it is considered a warning sign.


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