# Actinic Keratosis Conundrum



## pclaybaugh (Jun 19, 2018)

I may be going down the rabbit hole…it’s late in the day and I might be overthinking, but here goes…

A provider is documentation actinic keratosis and ICD guidelines state that a source is needed. This “source” is not documented. He has also coded 17000 as well as 17003. Past medical history states no personal history of skin cancer, which may very well be. 
I maintain that these are to be coded as lesion and the removal of benign lesions should be used unless there is further evidence in the documentation to prove otherwise.
Please opine. I am new to the derm world, be gentle.


----------



## mitchellde (Jun 19, 2018)

you should look close at the documentation.. did the provider render a diagnosis of an AK or did he assign a code for an AK.  If the provider rendered a bona fide diagnosis of an AK then as a coder we do not question a providers ability to do so.  However if this is just a code assignment with its standardized description then we must look to what diagnosis has been rendered.  If in the note the provider indicates a lesion or skin anomaly or it looks like an AK then you must use the L98.9 code for skin lesion.  We cannot assign benign neoplasm codes as a default, there must be a pathology report to use the benign or malignant or uncertain behavior codes.


----------



## pclaybaugh (Jun 20, 2018)

mitchellde said:


> you should look close at the documentation.. did the provider render a diagnosis of an AK or did he assign a code for an AK.  If the provider rendered a bona fide diagnosis of an AK then as a coder we do not question a providers ability to do so.  However if this is just a code assignment with its standardized description then we must look to what diagnosis has been rendered.  If in the note the provider indicates a lesion or skin anomaly or it looks like an AK then you must use the L98.9 code for skin lesion.  We cannot assign benign neoplasm codes as a default, there must be a pathology report to use the benign or malignant or uncertain behavior codes.



Greetings Michelle,

Thanks for the reply. I did look at this with fresh eyes and the provider did state the diagnosis, not just click the box. There was not a pathology report but I was told that this condition is diagnosible by sight.


----------



## ellzeycoding (Jun 21, 2018)

I think you re referring to "source" as external cause.

External cause reporting is not required unless a state regulation exists. I know of none for AK destructions.

ICD-10 guidelines state...

"Unless a provider is subject to a state-based external cause code reporting mandate or these codes are required by a particular payer, reporting of ICD-10-CM codes in Chapter 20, External Causes of Morbidity,* is not required.*"

So no source or external cause is required to be documented or billed.  L57.0 is fine alone.


On code assignment...

ICD-10 Guidelines, Section 1.A.19 state

"19. Code assignment and Clinical Criteria

*The assignment of a diagnosis code is based on the provider’s diagnostic statement that the condition exists. *The provider’s statement that the patient has a particular condition is sufficient. Code assignment is not based on clinical criteria used by the provider to establish the diagnosis."

Therefore, the physician can examine the lesion and based on clinical characteristics, determine that it is an AK and assign the ICD_10 code of L57.0.  In other words, histologic confirmation is not required.

AKs are rarely biopsied and sent to path.

99% of the time, the physician examines the raised, scaly, discolored lesions of a certain size (almost always in a sun-exposed area) and are able to determine with reasonable certainty that it is an AK.  They are most often destroyed with liquid nitrogen.


----------



## pclaybaugh (Jun 22, 2018)

Thank you, Karl! I appreciate the reply and the clear explanation.


----------

