# 2 lesions and one seb keratosis



## efuhrmann (Sep 25, 2009)

care to share opinions on this???  anyone???:
a) inflammed SK right upper back near the base of the neck anesthetized with xyl/epinephrine and excised with a Dermablade(17000???)
b) well circumscribed .3 cm hyperpigmented lesion from right scapula was excised with a 5 mm punch biopsy and hemostasis via 2 simple interrupted sutures;  benign(11300??)
c)right lateral superior breast with a irregular borders was exactly 6 mm in diameter and excised with 15 blade scalpel.  Path report "lentiginous compound nevus with mild architectural disorder and cytologic atypia extending to one lateral margin". Sutures to provide hemostasis.
This patient returned for a wide excision of the breast lesion which was deemed benign.


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## Susan (Sep 28, 2009)

efuhrmann said:


> care to share opinions on this???  anyone???:
> a) inflammed SK right upper back near the base of the neck anesthetized with xyl/epinephrine and excised with a Dermablade(17000???)
> b) well circumscribed .3 cm hyperpigmented lesion from right scapula was excised with a 5 mm punch biopsy and hemostasis via 2 simple interrupted sutures;  benign(11300??)
> c)right lateral superior breast with a irregular borders was exactly 6 mm in diameter and excised with 15 blade scalpel.  Path report "lentiginous compound nevus with mild architectural disorder and cytologic atypia extending to one lateral margin". Sutures to provide hemostasis.
> This patient returned for a wide excision of the breast lesion which was deemed benign.



Elizabeth;

For (a) you EXCISED, so your code would be size based in the 1142x code set, your diagnosis would be 702.11
For (b) you code would be 11400 with diagnosis 216.5
For (c) you would code 11401 with a 238.2

The rationale with everything is you excised therefore leading you to the 114xx code set.  There are many times when a surgeon will use a "punch tool" to excise a lesion so the operative report is very important to distinguish between a biopsy (11100) and an excision (114xx).  Hope this helps.


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## mitchellde (Sep 28, 2009)

I agree with most of what Susan states.  A punch always goes full thickness and therefoe is either a bx or an excision and the determining factor is wheter the entire (visible) lesion is removed, which then then makes it an excision.  I disagree with the dx code on C.  The pathology did not state neoplasm of uncertain behavior which is the 238.x codes therefore it is incorrect to use this category.  A pathology of nevus is coded to benign neoplasm, if you feel that the dx is still unclear then go with the 239.x codes for neoplasm unspecified which is a category that may be used after preliminary workup states non definitive findings such as tumor.  This is more correct and not as damaging to the patient in the long run.


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## Susan (Sep 28, 2009)

Debra;

With the pathology it states:

lentiginous compound nevus with mild architectural disorder and cytologic atypia extending to one lateral margin".

The architectural disorder and cytologic atypia could be read as a dysplastic nevus and therefore 238.2 would be the correct diagnosis.  I don't see this lesion being completly benign and it is not malignant so I would choose the 238.2.


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## mitchellde (Sep 28, 2009)

It is not uncertain either I would go with unspecified 239.x .  The pathologist must state uncertain behavior this was covered in coding clinics several years back.  Unspecified is a dx code that can be used as a working dx when patology is neither benign or malignant and further study is planned as a result.


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