Ophthalmology and Optometry Coding Alert

Question: Which diagnosis codes should I use for removal of a benign lesion?

California Subscriber

 
Answer: You could use a number of diagnosis codes, including 215.0 (Other benign neoplasm of connective and other soft tissue; head, face, and neck), 216.1 (Benign neoplasm of skin; eyelid, including canthus), 224.0 (Benign neoplasm of eye; eyeball, except conjunctiva, cornea, retina, and choroid), 224.3 ( conjunctiva), 224.4 ( cornea), 224.6 ( choroid), 224.8 ( other specified parts of eye), 224.9 ( eye, part unspecified) and 225.0 (Benign neoplasm of brain and other parts of nervous system; brain).
 
Any growth needs to be biopsied to determine the best diagnosis code. Code selection depends on the site. Many offices bill it as benign because they dont want to wait for pathology reports. But benign lesions can look malignant, and malignant lesions can look benign on gross examination, so it is always recommended that the claim be held until pathology reports indicate the diagnosis.
 
One diagnosis code for skin tag may be denied as medically unnecessary: 701.8 (Other hypertrophic and atrophic conditions of skin; other specified hypertrophic and atrophic conditions of skin).