# Dx for Biopsy ? - I have read many threads regarding



## cpccoder2008 (Feb 18, 2009)

I have read many threads regarding this issue and i am still confused. From what i was taught you should wait till you get the path results to code a biopsy. I have been coding my Ophthalmology clinic that way. I have just taken over dermatology and have been taught different. The doctor insist on using 238.2 for every biopsy she thinks is BCC. For the diagnois in the chart she writes Basel Cell Carcinoma. I do not feel confortable using this dx until i get a final path report stating it is indeed BCC. I have been searching this issue on the internet and found this website http://www.skinandaging.com/article/8308

It states " _Codes to Use When Waiting for Biopsy Results 

As you noticed, in all of the above examples, I used either ICD code 238.2 (Neoplasm of skin, unknown origin) or 782.1 (Non-specific skin eruption) for diagnosis codes. These ICD codes are available for you to use so that you do not have to wait for biopsy results before billing your charges. Not only will this facilitate your payment, but it will also make life much easier for your office staff by eliminating paperwork. 

There is absolutely no reason for you to know the diagnosis to code for a biopsy. Regardless of the diagnosis (malignant or benign), reimbursement is the same. Only excision codes are reimbursed at a higher level for malignant lesions. 

Actually, if you use the biopsy results as your ICD code for biopsies, you may face this question in a future audit, “Why did you biopsy this lesion, doctor, if you already knew that it was a basal cell carcinoma?” Therefore, it is highly recommended to use these two ICD codes (238.2 or 782.1) for your biopsies._ 

Can someone please clarify this ? 

Thanks


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## FTessaBartels (Feb 18, 2009)

*Biopsy vs Excision*

Your doctor is incorrect to diagnose BCC without the path. Never give a patient a disease they do not have. 

The writer of the article however is correct that you need not wait for path to code the *biopsy*. There is no difference in coding the biopsy based on what the ultimate findings are. 

You *must* wait for path to code the *excision*, because there is a difference between excising a benign lesion and excising a malignant lesion. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## elenax (Feb 19, 2009)

I agree with FTessa; I always wait for the path report.


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## cpccoder2008 (Feb 19, 2009)

She is writing BCC as the diagnosis on the chart but on our billing tickets she is putting 238.2

On her exam she will write nodule on cheek and then in her final diagnosis she puts BCC. I was always taught to code from the medical records not our billing tickets. I have been changing the dx to 782.2 Nodule of the skin, since that is what she is documenting in the charts. What would she have to document in order to use 238.2 ? I just don't feel comfortable using 238.2 unless i'm reading the results from a path. If it isn't neoplasm then you shouldn't code it as so. I would perfer to use 782.2 or 782.1


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## Anna Weaver (Feb 19, 2009)

*biopsy*

I think I would go with whether it was an actual excision of a lesion or a biopsy, there's a difference here. 
If she excised the entire lesion (I know those that say it's a biopsy because they send it to pathology), I would wait on the Path report. (reimbursement is dependent on diagnosis because it makes a difference whether its malignant or benign)
If she did a biopsy (just removed a part, but not entire), the 238x would be okay to use before the path report is completed. (reimbursement is not affected)


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## cpccoder2008 (Feb 19, 2009)

Yes she did a biopsy, so it's ok to use 238.2 ?


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## cpccoder2008 (Feb 19, 2009)

I understand that reimbursement will be the same regardless of what dx she uses but i just wasn't sure if 238.2 was ok given that she documents BCC on the medical records. She is only performing a biopsy which is why she doesn't want to wait for the path results to code.


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## Anna Weaver (Feb 19, 2009)

*biopsy*



cpccoder2008 said:


> I understand that reimbursement will be the same regardless of what dx she uses but i just wasn't sure if 238.2 was ok given that she documents BCC on the medical records. She is only performing a biopsy which is why she doesn't want to wait for the path results to code.



Sorry, I wasn't very clear with that. I would have her clarify if the patient has BCC diagnosis or if it's a question of BCC. If it's question of, then the 238 dx is okay. If she says she knows it is BCC, then I'm afraid I would wait for the path report (definitive diagnosis). I have always been told to be conservative when it comes to coding cancers. Once they have been diagnosed, it's almost impossible to get them off the record. Is this any clearer? Sorry about that.


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## cpccoder2008 (Feb 19, 2009)

It's a question of _IF_ they have BCC which is why i think she uses 238.2 

Thanks everyone !!


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