# Excision of Uncertain Behavior Lesion



## naandersn (Nov 1, 2011)

If the pathology comes back as  "Keratoacanthoma" uncertain behavior........should the benign excision codes be used?


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## FTessaBartels (Nov 4, 2011)

*238.2 is NOT classified as malignant*

Since ICD-9 238.2 (Keratocanthoma, unspecified behavior) is *NOT* classified in the Neoplasm table as Malignant,  I would use the benign excision codes.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## mitchellde (Nov 4, 2011)

There was a CPT assistant some time back that covered this and it stated that if the path comes back as uncertain then we go back to the details of the excision to figure out the CPT code.  If the excision had narrow margins or is documented as a scar sparing technique then we code it as benign CPT, if the margins are wide or documentation states a wide excision then we code it as malignant CPT.


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## jmastel (Nov 9, 2011)

You choose benign excision vs. malignant excision according to diagnosis, not margin size. Benign excision would be correct, unless the Pathologist indicated evidence if squamous cell carcinoma or scc in situ, then you would bill malignant excision.


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## sauka (Nov 9, 2011)

jmastel said:


> You choose benign excision vs. malignant excision according to diagnosis, not margin size. Benign excision would be correct, unless the Pathologist indicated evidence if squamous cell carcinoma or scc in situ, then you would bill malignant excision.



Thus true and if the the result does not say malignant then thus benign.
XS

sauka


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## mitchellde (Nov 9, 2011)

jmastel said:


> You choose benign excision vs. malignant excision according to diagnosis, not margin size. Benign excision would be correct, unless the Pathologist indicated evidence if squamous cell carcinoma or scc in situ, then you would bill malignant excision.



That goes contradictory to the AMA instruction, But what they say makes sense, if the provider feels the result will likely be benign then he creates a smaller scar, therefore smaller margins, if the provider fears the result is likely malignant then he will take large margins in an effort to avoid a re-excision due to positive margins.  Uncertain behavior is cellular activity cannot be classified as either benign  or malignant so the only thing you have to go by is the intent of the provider which is evident by the margin size.  If you have an official source to support your instruction I would like for you to post it so that it can be accessed.


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## CULINTZ (Feb 4, 2019)

Can anyone provide the CPT Assistant that references how to code neoplasms with pathology of uncertain behavior? I no longer have access to online coding references. Thanks in advance.


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## mitchellde (Feb 4, 2019)

It was several years ago probably in the 1980s.  If anyone does have it the only information they could give is the issue number and year and a brief synopsis of the information in their own words.  However that should be sufficient information.  As far as I know there was not a more recent Assistant with this information nor was it ever overruled.


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## sclement@penbayhealthcare.org (Feb 4, 2019)

*Excision of Uncertain Behavior Lesion - CPT Assistant May 1996*



mitchellde said:


> It was several years ago probably in the 1980s.  If anyone does have it the only information they could give is the issue number and year and a brief synopsis of the information in their own words.  However that should be sufficient information.  As far as I know there was not a more recent Assistant with this information nor was it ever overruled.




Here is what I found from CPT Assistant May 1996:


Surgery/ Integumentary

Question

When a lesion is removed that turns out to be a neoplasm of uncertain morphology (eg, melanoma vs dysplastic nevi), is it correct to use excision of benign neoplasm rather than excision of malignant neoplasm?

AMA Comment

"Uncertain behavior" identifies tissue that is beginning to exhibit neoplastic behavior but cannot yet be categorized as benign or malignant. Additional or further testing is required. To ensure correct coding, the removal of the neoplasm should be coded after receiving the pathology report.

When the morphology of a lesion is ambiguous, choosing the correct CPT procedure code relates to the manner in which the lesion was approached rather than the final pathologic diagnosis, since the CPT code should reflect the knowledge, skill, time, and effort that the physician invested in the excision of the lesion. Therefore, an ambiguous but low suspicion lesion might be excised with minimal surrounding grossly normal skin/soft tissue margins, as for a benign lesion (codes 11400-11446), whereas an ambiguous but moderate-to- high suspicion lesion would be excised with moderate-to- wide surrounding grossly normal skin/soft tissue margins, as for a malignant lesion (codes 11600-11646). Thus, the CPT code that best describes the procedure as performed should be chosen.


 (No revisions to date)


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## CULINTZ (Feb 5, 2019)

Thanks much!


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## mitchellde (Feb 5, 2019)

sclement@penbayhealthcare.org said:


> here is what i found from cpt assistant may 1996:
> 
> 
> Surgery/ integumentary
> ...


you are awesome!!


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