Ophthalmology and Optometry Coding Alert

READER QUESTIONS :

UsingWrong Lesion Size Can Shrink Payment

Question: When determining the size of an excised lesion, should I go by the operative report or by the pathology report? Our ophthalmologist says that the lesion area excised was larger than the pathology report says. Florida Subscriber Answer: Dont wait for the pathology report for your information about a lesions size unless no other source is available. Once the surgeon cuts the tissue out, the lesion loses its tension and gets smaller. The formalin used to preserve the tissue before it goes to the lab can shrink the sample even further. So if you wait for the path report to code, the lesions will be much smaller, and youll be kissing well-deserved payment goodbye. Use the lesion and margin size before the excision, as documented by the ophthalmologist in the operative report, to arrive at a lesion excision code.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Ophthalmology and Optometry Coding Alert

View All