Primary Care Coding Alert

Question: Our physician excised a 0.4 cm lesion and documented, "She has a bleeding black lesion on the right chest wall." The payer denied our claim with diagnosis 709.9 because we needed a secondary diagnosis. The pathology report documented the lesion was a benign seborrheic keratosis. We added 702.19 to the claim but received another denial for medical necessity because the LCD guidelines state both those diagnosis codes are considered primary. What should we do now?

Indiana Subscriber

Answer: Choose between 702.11 (Inflamed seborrheic keratosis) or 702.19 (Other seborrheic keratosis) for the primary diagnosis, depending on whether the physician noted any inflammation. The fact that the physician noted the lesion was bleeding suggests that it was inflamed. Do not add 709.9 (Unspecified disorder of skin and subcutaneous tissue), because it is an unspecified code that is no longer pertinent in light of the more definitive diagnosis provided by the pathology report.

Also ensure that you're reporting the correct procedure code. Submit 11400 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter 0.5 cm or less) if the excised diameter (i.e., the 0.4 cm lesion plus margins) was 0.5 cm or less. If the excised diameter extended to between 0.6 and 1.0 cm, then you would report 11401 (excised diameter 0.6 to 1.0 cm).