# residual BCC ?



## MEZIESKY (Aug 4, 2009)

I work for 13 general surgeons. One does alot of excision of lesion ect....
I see alot where a patient will come in for a consult from a derm dr. where the had a bx and have BCC or a malignat melanoma. Our dr. looks at thier path for the diag. and then removes either in the office or the OR the remaining BCC or melanoma. When our path comes back it is negative or sayes residual BCC. How do we code the diag as well as the procedure.  The patient came in with a previous path saying malignant and when we removed the remain portion of the melanoma the path comes back benign. Hope that makes sense. This is very frustating. Patient is coming in from somewhere else with a path saying malignant can we use that as our diag for the consult? and what about the procedure when our path comes back residual or benign? Any input on this would be great. 
Thank you
Marie


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## FTessaBartels (Aug 4, 2009)

*Excision of residual carcinoma*

If you have a prior pathology report indicating malignancy, and the patient is being sent to you for a wider excision (I'm assuming to ensure that all the cancer has been removed), then I would code excision of malignant lesion. 

If the patient is being sent to you *for the procedure *you do *NOT* have a consult ... it is a transfer of care. If your E/M is significant, separately identifable service from the procedure, then code either a new patient or an existing patient visit (depending on whether the patient has been seen by anyone in your practice and specialty in the last 3 years).  Keep in mind that all procedures include an appropriate E/M as part of the RVUs of the procedure. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## mitchellde (Aug 4, 2009)

Tessa and I are of one mind on this one!


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## MEZIESKY (Aug 4, 2009)

Thank you very much for you help.
Marie


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