# Dx help



## LadyT (May 7, 2009)

Physician did biopsy on pt arm that had been previously LN2 & is now sore & wont heal. Physcian felt biopsy was needed to rule out SCC.Path came back as scar. Do I use 238.2 as primary DX and scar as secondary?? Any help would be apperciated.


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## katerock1 (May 8, 2009)

yes.  Intent was to see if it was SCC, it ended up being a scar.


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## LadyT (May 8, 2009)

That is what I thought too, just wanted someone else to give input. Thanks for your time & help.


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## mitchellde (May 8, 2009)

No this is not the correct dx code.  The pathology did not say this was a neoplasm of uncertain behavior.  The dx codes under this heading may be selected only after pathology says this is the dx, these codes do represent when the physician is unsure.  They mean that after microscopic visualization the pathologist observes cellular behavior that is uncertain.  The correct way to code this would be V71.1 first listed and then the code for the scar second.. to indicate the necessity for the excision was suspected malignancy not found.  I hope this helps
Debra Mitchell, MSPH, CPC-H


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## mitchellde (May 8, 2009)

Sorry that is do NOT represent when the physician is unsure, I apologise ofr the confusion


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## LadyT (May 8, 2009)

mitchellde said:


> No this is not the correct dx code.  The pathology did not say this was a neoplasm of uncertain behavior.  The dx codes under this heading may be selected only after pathology says this is the dx, these codes do represent when the physician is unsure.  They mean that after microscopic visualization the pathologist observes cellular behavior that is uncertain.  The correct way to code this would be V71.1 first listed and then the code for the scar second.. to indicate the necessity for the excision was suspected malignancy not found.  I hope this helps
> Debra Mitchell, MSPH, CPC-H



Thanks soo much this makes sense to me! Thanks again for your time


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## Susan (May 8, 2009)

LadyT said:


> Physician did biopsy on pt arm that had been previously LN2 & is now sore & wont heal. Physcian felt biopsy was needed to rule out SCC.Path came back as scar. Do I use 238.2 as primary DX and scar as secondary?? Any help would be apperciated.




NOOOO...  238.2 is used for a neoplasm of uncertain behavior, such as a dysplastic nevus.  

If you waited to code the biopsy (11100) for the path that came back a scar, then the correct diagnosis would be 709.2, if the documentation indicated that this was keloid or hypertrophic scar then the diagnosis would be 701.4.

If you sent the claim out before the pathology came back then your diagnosis would be 239.2.  Check the documentation to see if you could back up your diagnostic coding by adding a 782.2 or 782.0

I hope that all makes sense!


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## mitchellde (May 9, 2009)

I respectfully disagree with Susan.  Neoplasm of Uncertain Behavior codes are not to be assigned untill that dx is rendered by a pathologist.  Their definition is that they are morphohistopathologic diagnosis.  The keyword here is Behavior, until observed under a microscope we cannot guess at the behavior of the cells.  Neoplasm Unspecified may be rendered only after a preliminary workup reveals that this is a neoplastic process but not of what type like a dx of tumor for example.  When you say that 238 can be used with displastic nevi that is incorrect it can be used once Pathology says it is of uncertain behavior..  Also if the scar is excised and sent for path then we must wait for the path report before we can code it.  A biopsy is a removal of only a piece of a lesion and therefore you are not required to wait for path but you then are limited to what you know and that is this is a scar, like a 709, or 701 variety.   We cannot have coders diagnosing the patients and are restricted to just what we see in the medical record, usually what we see is documentation to support suspician for malignancy which is what she had and then the path is benign.  That is why V71.1 is a perfect fit and it is required to be first.  Sorry this is so long but I felt clarification was necessary.
Debra


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## Susan (May 12, 2009)

Debra;

While I understand what you are saying in this situation I would say that the V71.1 would be correct with the scar code being coded second.

The point that I was trying to make was that when coding for a biopsy and submitting prior to receiving the pathology I have use the 239.2 and have been successful in getting paid.  Though I really like the V71.1 to support medical necessity.

This particular issue I see as very much being a carrier driven decision.  That is why I typically try to tell people to check with their carrier and see what the carrier policies are regarding diagnostic coding.

I still strongly disagree with the coding that LadyT was wanting to do in this situation as she was coding something PRIOR to having the pathology report.  Once anyone has a pathology report, then we as coders are correctly coding if we code directly from the pathology report itself.

Respectfully;


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## LadyT (May 12, 2009)

Susan, 
 I guess Iam still a little confussed... I was trying to DX after path was back that is how I know the DX was scar. So would it then be correct to use the scar then V71.1?


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## mitchellde (May 12, 2009)

Yes LadyT that is correct.  Susan, regardless of the fact that you got paid with the 239 code it is still incorrect as you have not met the definition for a neoplasm unspecified.  If the physician documents that this is in fact an unspecified neoplasm which required further workup, then I will agree, but not if the documentation shows a suspicious skin anomoly and a piece of it was taken for biopsy.


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