Wiki 611.3 Fat Necrosis of Breast

[Nichole9288]

We have a patient who was seen for a fat necrosis of her breast, status post breast reduction. The surgeon and patient decided upon an incisional breast biopsy to evaluate & diagnose the breast lump. (Past the 90 day global period).
The diagnosis on the pathology report came back as 611.3 (fat necrosis breast).
The insurer is kicking back our claim stating we can't bill 611.3 as the primary dx because the ICD9 book states "code first 996.79 breast necrosis due to breast graft).

Well, the patient didn't have an implant or graft.


What should we do in this case?

Thanks, Nichole

 

[wfriddle]

sign or symptom

I would use breast lump/mass, 611.72, since it sounds like that is what her chief complaint was when she came in. If you had sent the claim before the path came back that is all you would have been able to use.

 

[Nichole9288]

If I do have the pathology back though shouldn't I use the 611.3 known diagnosis code?

 

[wfriddle]

I do believe you are correct since that is the highest degree of certainty.
I am very confused by these codes. I can kind of understand why it would need a primary diagnosis because the fat necrosis was probably casued by trauma d/t her surgery but that just does not fit the code descriptor at all. I am at a loss. Sorry. I would love to hear some suggestion from others though.

 

[Nichole9288]

Thank you Wfriddle, that's kind of what I feel too.

Does anybody out there have any other ideas?

Thanks so much!

 

[Anna1962]

You might consider 611.89 "Other specified disorders of the breast"