Oncology & Hematology Coding Alert

Question: Our provider excised an area of patient’s skin and sent it off to pathology. He reported D49.2 as he did not know the status of the excised tissue. Is this a diagnosis that insurance will consider? And if the pathology diagnosis disagrees with this, is the original diagnosis incorrect, and does the provider have to go into the original note and change it?

AAPC Forum Participant

Answer: If the excision was reported as a biopsy using the appropriate biopsy procedure code, your surgeon would be right to use the D49.2 (Neoplasm of unspecified behavior of bone, soft tissue, and skin) in the note because they do not know the final diagnosis until pathology comes up with the definitive diagnosis. However, if there was no other medical necessity to support the full excision removal of the lesion, the insurance carrier may deny as not covered by their policy. For example, Medicare will only reimburse removal of lesions with evidence of disease or other limited circumstances.