Coding Quiz Answers

Check your responses against these expert answers provided by Marcella Bucknam, CPC, CCS-P, CPC-H, coordinator of health information management (HIM) certificate programs at Clarkson College in Omaha, Neb.:
Answer 1. False. "Coders should never guess about pathology in coding lesion removals -- you should make every effort to obtain the pathology report," Bucknam says. But if you absolutely can't get the report, you must code the lesion removal as benign, regardless of whether the physician believes it is.
Answer 2. True. For instance, if the physician removes a 0.5-cm malignant lesion from a patient's chest, you should report 11600 (Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.5 cm or less).
Answer 3. False. Prior to the procedure, your physician should measure the largest diameter of the lesion, as well as the smallest margin she'll leave around the lesion. "Once the skin is cut," Bucknam says, "both of these measurements will decrease, and they decrease even further if the coder must wait to get the information from the pathology report." The physician needs to write both measurements on the procedural report so you can select the right code.
Answer 4. False. Reporting these procedures together is contrary to CPT guidelines for lesion removal coding. "Each lesion is treated separately, and it would be inappropriate to add together or otherwise bundle the lesions into a single code," Bucknam says. When the doctor removes several lesions from the same area on the patient's body, you should bill each procedure separately. Most payers require you to use a modifier, such as modifier -59 (Distinct procedural service).

- Published on 2004-07-09