# Dermatology and Modifier 59



## maynard1 (Jun 11, 2009)

:I work BCBS Internal Med.  I don't really have a lot of Dermatology Exp.
Can someone tell me if this would be correct:  
99203 25  238.2
17000      702.0
17003      702.0
11100 59  238.2

Thanks 
SMaynard


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## mitchellde (Jun 11, 2009)

Without seeing the note I am not sure if you are correct.  However without a path report or the physician stating that the dx is a neoplasm of uncertain behavior you may not use that dx.  That is a dx that is determined after a microscopic examination of the cells.  The physicians I have worked with would never state this in the documentation unless the path report states it.   If you will paste the documentaton here then we can be of more assistance


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## maynard1 (Jun 11, 2009)

You are correct about the path report and  he does actually wait for the report before he codes.  I just always have a problem with BC bundling the 11100.  Do you find you have to appeal?

Thanks 
SMaynard


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## mitchellde (Jun 11, 2009)

So can I ask, is the bx and the destruction three separate lesions?   The bx is performed and the path came back as uncertain behavior and the other 2 were destructions of AKs?


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## LTibbetts (Jun 12, 2009)

I was told that as of June 1st, according to CMS, skin lesions are to be reported as neoplasms of uncertain morphology, if coded prior to identification of the specimen.
"If a benign skin lesion excision was performed, report the applicable CPT code, even if final path demonstrates a malignant or carcinoma in situ dx for the lesion removed. The final path does not change the CPT code of the procedure performed. An ambiguous but low suspicion lesion would be reported as a benign lesion (11400-11446) reflecting the procedure that was performed. A moderate-to-high suspicion lesion may be reported as a malignancy (11600-11646), if the appropriate excision was performed. To report removal of lesions of uncertain morhphology, prior to ID of the specimen, report ICD-9 239.2 (neoplasms of unspecified nature, bone, soft tissue and skin), or 709.9 (unspecified disorder of skin and suncutaneous tissue) since proper coding requires the highest level of dx known at the time the procedure was done ICD-9 709.9 will be added to the list of payable dx's in tthe LCD."

I know that this is not a medicare patient that you are dealing with but I just thought it might be good information to have regarding lesion coding guidelines.


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## mitchellde (Jun 12, 2009)

The above reference is to use 239 for unspecified when the morphology is uncertain, not 238 for uncertain.  Also this is an LCD which applies only to certain regions not all.  Several of us have discussed this LCD on a different post and most of us really disagree with it.


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## LTibbetts (Jun 12, 2009)

Which post would that be? might be good info to know....


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## mitchellde (Jun 12, 2009)

I think it is in the surgery section or internal medicine... but UPDATE!   I just received a communication from John Verhovshek at AAPC and he says this has been reversed and he is getting me the information on this to pass on so hold on I will get this to everyone as soon as possible.
Debra Mitchell, MSPH, CPC-H


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## SherryMoss (Jun 16, 2009)

Assuming that the biopsy was a separate site from the AK destructions, yes...looks good to me.  How many AK destructions were there, by the way?  ('cause 17003 is "by the each")


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## Melan (Jul 8, 2009)

*239.2 vs 238.2*

My understanding is that 239.2 is appropriate if a dx has not yet been given by the pathologist (not yet specified).  238.2 is when the pathologist has read the slide and cannot give a difinitive dx. (uncertain).  So on the day that the biospy was performed a diagnosis is pending so 239.2 would be used.  Any thoughts on this?


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