General Surgery Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer. Question: Our surgeon removed a lesion, but the pathologist is unable to determine if it is malignant or benign and has recommended a wide excision, "just to be safe." How should I categorize the lesion? Georgia Subscriber

 Answer: If the status of the lesion is uncertain, use the code for excision of benign lesion (114xx) and include a diagnosis "of uncertain behavior." Report the wide excision using 114xx and append modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) to indicate that the surgeon staged the second procedure (the wide excision) because it occurred during the postoperative period of the first procedure.

Note that Medicare does not pay for benign lesion removals unless specific criteria are met: The lesion must be impairing function, suspect for possible cancer or in a location that often receives trauma, or a carrier will assume the procedure is cosmetic. To receive reimbursement without appeal, include a letter with the claim form indicating which of the above criteria the lesion meets.