# Need help with Dx's Code



## aferris86 (Nov 22, 2010)

Hi,

What would be the proper diagnosis code for lesions of the left nose and lower lip?

I thought about using 709.9 but am not sure.

Thanks.

aferris86


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## mitchellde (Nov 22, 2010)

709.9 or 709.8 is all you have until you have a path report.  If performing an excision, you are required to wait for the path before you can code and submit a claim.


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## aferris86 (Nov 22, 2010)

Thanks.

aferris86


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## aferris86 (Nov 22, 2010)

This was actually for a Code-a-Round scenario that I had to finish.

Thanks again!

aferris86


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## eadun2000 (Nov 22, 2010)

aferris86 said:


> Hi,
> 
> What would be the proper diagnosis code for lesions of the left nose and lower lip?
> 
> ...



709.9 is good for the nose, but lesion for the lip is 528.5.


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## mitchellde (Nov 22, 2010)

eadun2000 said:


> 709.9 is good for the nose, but lesion for the lip is 528.5.



I disagree... 528.xx codes are for diseases of the oral soft tissues and 528.5 is disease of the lip, but it would need to be consistent with the code category and be the soft tissue of the lip.  If this is the vermillion border then it is not the soft tissue, and a lesion is not necessarily a disease.


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## eadun2000 (Nov 22, 2010)

mitchellde said:


> I disagree... 528.xx codes are for diseases of the oral soft tissues and 528.5 is disease of the lip, but it would need to be consistent with the code category and be the soft tissue of the lip.  If this is the vermillion border then it is not the soft tissue, and a lesion is not necessarily a disease.



I disagree.  If you pick up your ICD-9 book and look in the index under lesion, then look for lip, it states 528.5.  Nothing was said about the vermillion border.  All that was said was lower lip.  If you are looking for a code for a lesion of the lip it IS 528.5.


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## mitchellde (Nov 23, 2010)

The upper and lower lips include the vermilion border. This is the juncture between the lighter skin and the redder tissue (vermilion) that we commonly call the lip. This tissue is red because the skin is thin and there are many small blood vessels (capillaries) underneath it. The vermillion is different than oral mucosa because it maintains an outer layer of cells (stratum corneum) and it does not contain any salivary glands.
When we use the alpha index to illicit a code we must also use basic anatomy to help us in our code selection.  the lip as in the upper or lower is the vermillion tissue and is not inclusive of the oral soft tissue which would be inside.  The vermillion border is part of skin.


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## eadun2000 (Nov 23, 2010)

I am not going to go back and forth on this.  If all it states is "lesion on lip" then all you can code is 528.5.  It does not state where exactly on the lip... it just says lip.


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## mitchellde (Nov 23, 2010)

Then query the physician to see if it is indeed on the innerside to be the oral soft tissue area.  Just because the alpha leads to a certain code is no indication that code is the correct one.  Also we must use the main category heading as part of the code descriptor so again the 528 category is for diseases of the oral soft tissue.  The lip has the outer vermillion area which is skin and the inner soft tissue area.  If you are not sure this is the outer skin portion to be 709.9 then you should query the physician to be sure it IS the oral soft tissue area of the lip.


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