# Dysplastic Nevus DX Help



## Amanda Victoria Lewis (Jun 17, 2010)

Hello Fellow CPC's,
I am having an issue with the theory behind the coding of a dysplastic nevus of the" back", confirmed by pathology report. I know that a dysplastic nevus has characteristics of a malignant lesion, although it is really not considered malignant. So here is my issue. What code do I use 238.2 or 216.5? My only issue with 238.2 is if you look in the 2010 ICD-9 book under the tabular listing it says right under 238.2 "TIP: Assign this code for keratocanthoma only". That would make me lean towards the other code. Or is keratocanthoma the same thing as a dysplastic nevus (I don't really think so)? Do I ignore this tip in the tabular listing? I was taught that I should pay close attention to all the little notes in the tabular listing because it will help you choose the proper code. Plese help. Which code 238.2 or 216.5?
Thanks
Amanda Lewis
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## mitchellde (Jun 17, 2010)

dysplastic nevi are moles that are usually slightly larger than typical moles and can develope into malignant melanoma but for now it is a mole, code it benign.


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## vj_tiwari (Jun 18, 2010)

Hey,

I think 216.5 is the one! 

A dysplastic nevus (also known as a: Atypical mole, Atypical nevus, B-K mole, Clark's nevus, Dysplastic melanocytic nevus, Nevus with architectural disorder[1]) is an atypical melanocytic nevus;[2] a mole whose appearance is different from that of common moles. Dysplastic nevi are generally larger than ordinary moles and have irregular and indistinct borders. Their color frequently is not uniform and ranges from pink to dark brown; they usually are flat, but parts may be raised above the skin surface. Dysplastic nevi can be found anywhere, but are most common on the trunk in men, and on the calves in women.

Keratoacanthoma (ICD 9 CM code is 238.2) is a relatively common low-grade malignancy that originates in the pilosebaceous glands and closely resembles squamous cell carcinoma (SCC). In fact, strong arguments support classifying KA as a variant of invasive SCC. The pathologist often labels KA as "well- differentiated squamous cell carcinoma, keratoacanthoma variant". KA is characterized by rapid growth over a few weeks to months, followed by spontaneous resolution over 4–6 months in most cases. KA reportedly progresses, although rarely, to invasive or metastatic carcinoma; therefore, aggressive surgical treatment often is advocated. Whether these cases were SCC or KA, the reports highlight the difficulty of distinctly classifying individual cases.

And hey... paying attention to tabular list is really a good thing, so dont't avoid. Also when you are not coming to any specific code viz., cancer, neo. etc please refer to morphology of neoplasm in ICD 9CM.

Hope this helps! 

VJ.


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## Amanda Victoria Lewis (Jun 18, 2010)

Thanks A Million everyone.


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