Wiki 11602 with dx 238.2 /173.9 ???

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Dolores McKenzie

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I have a provider that has submitted a 11602 with dx 173.9.

However, The path report states Keratoacanthoma dx 238.2. (Uncertain Behavior) The Path does NOT confirm a Malignancy but the provider has coded it as malignant. dx 173.9 and does not want to change it to 11402 Benign.

The patient does have a personal hx of Skin ca V10.83, which he did not include on the encounter.

Is this correct coding? I have always been instructed if the Path report does NOT confirm a malignany, you should bill this as Benign (11402) and list the 238.2 as the dx.

I can not find any documentation guidelines on this to prove this to the provider. Please help asap !!

Thank you
 
I think you should use the diagnosis that is on the pathology report, of course you will need to change your procedure code as well. I have surgeons that say they are using the Malignancy code before they get the path report back and I have to change the procedure code once we get the report.

Just my opinion.
 
When you have uncertain behavior pathology the CPT code then depends on the size of the margins. If thew provider excised the lesion with wide margins then you code with malignant excision, if he excised with narrow margins then you code with benign excision. Either way you use the 238.2 dx code. This is from an older CPT assistant.
 
11602

Thank you for your reply ....Can you tell me what size distinguishes Wide vs Narrow Excisions? This was a 1.5 cm excision.

I was always lead to believe the path report is what determines the benign or malignancy
CPT code to be billed. That is the main reason we wait on the path report :confused:

If you know what month/yr this information came from CPT assistant I would be eternally grateful :)
Or can shed any other information on this :)
Thank you!
 
Dolores McKenzie said:
Thank you for your reply ....Can you tell me what size distinguishes Wide vs Narrow Excisions? This was a 1.5 cm excision.

I was always lead to believe the path report is what determines the benign or malignancy
CPT code to be billed. That is the main reason we wait on the path report :confused:

If you know what month/yr this information came from CPT assistant I would be eternally grateful :)
Or can shed any other information on this :)
Thank you!
Click to expand...
You will have to know the size of the lesion and the size of the excision to know if it was wide or narrow. The path report does determine the CPT code however uncertain behavior sits on the fence, that is why then the size of the margins determines then the CPT code. I do not remember the CPT assistant this was from but it would have been somewhere around 2000 to 2001, I am sorry I cannot be more specific but it was some time ago.
 
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