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Wiki Advice on waiting for pathology or not to report diagnosis?

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Brandy0618

Brandy0618

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Good afternoon. One of our physicians has posed a good question. One that I do not have the answer for. How do we wait and report a pathology diagnosis to apply to the original encounter when that pathology diagnosis will not line up with the original encounter note? If an area is excised for pathology and the original encounter reports "unspecified" as this is correct. The provider does not know what it is and the clinical note denotes this, if the pathology diagnosis is reported on the note it is not going to line up with the original note that states the physician is excising because the area is concerning and it needs to be sent to pathology. Does the provider have to change the entire clinical note? In addition, if the provider reports D49.2 if they do not wait for pathology, is this a diagnosis that carriers will even consider since it is "unspecified?" Or L98.8? Thank you for any advice and or direction on this. :)
 
Hi Brandy
The doctor seems gave you the correct codeD49.2 , but if the lab results may change to something more such as: in situ , malignant, uncertain, carcinoma, Etc. We were always told to wait till got lab results return before coded this info. It is better to wait till results come back to code it with most details. I hope you are allowed to read the lab results. If not allowed code it D49.2 . Part of the medical coding is to use most details to ensure correct coding. But go by your protocol at your office. Also when do lab CPT coding for skin bx of lab codes range from CPT 88302 to 88305 which connect to type of skin imperfections if provider documented such as: skin tag, wart, cyst, lipoma, mass, nevus, pilar cyst, boil or mass on certain body areas. Here are the dx blocks to consider....... Lipoma D17 Boil L02 Skin lumps mass R22 Wart dx B07 or L82 Lesion L89 M.Nevi D22 Cyst L05 Skin changes R23.4 Unspecf Neoplasm skin bone D49.2 Benign Neoplasm per body area D21 to D25 per providers documentation.

Also do not forget to end the claim with Z dx. code describe encounter fit patient circumstances such as.......
Z12.83 Encounter malignant skin Z13.89 Encounter for unknown disorder Z87.2 History of skin disorder Z85.820 Personal History of malignant skin DO
Z86.018 Personal HO of benign neoplasm skin

I hope this data helps you:)
Lady T
 
Hello, I agree with Lady T's response above. It is always best to wait for the pathology diagnosis to bill the claim correctly. You may not bill that uncertain behavior code unless the pathology diagnosis specifies Uncertain Behavior. Your surgeon is okay to post the D49.2 diagnosis code because she or he also does not know the final diagnosis unless a frozen section was done. It would be better to use "mass" instead of uncertain behavior. This is something we surgery coders & instructors struggle to teach the surgeons. The language means one thing to a clinician and another thing to a certified coder. If you mean the initial consultation/office visit when you say "original encounter", you would indeed use either a general "mass" code or if surgeon is pretty sure the mass is a lipoma, you can bill one of the the D17.x codes. Payers understand the process. They understand that there is likely to be an unspecified initial diagnosis code and final, correct by pathology diagnosis code for the surgery. I taught my surgeons to use "mass" unless they were sure of a lipoma. Lady T is absolutely correct: Use of a "Z"-code is appropriate and important if there is history of malignancy, lipoma, or anything else related to the potential diagnosis, such as history of radiation or chemotherapy. I hope this helps to explain the world of coding to your surgeon. This is what I teach my students: There is "surgeon-speak" and there is "coder-speak". Our job is to mesh the two, helping our surgeons along the way. And, yes, your surgeon posed a very good question.
 
pkidd said:
Hello, I agree with Lady T's response above. It is always best to wait for the pathology diagnosis to bill the claim correctly. You may not bill that uncertain behavior code unless the pathology diagnosis specifies Uncertain Behavior. Your surgeon is okay to post the D49.2 diagnosis code because she or he also does not know the final diagnosis unless a frozen section was done. It would be better to use "mass" instead of uncertain behavior. This is something we surgery coders & instructors struggle to teach the surgeons. The language means one thing to a clinician and another thing to a certified coder. If you mean the initial consultation/office visit when you say "original encounter", you would indeed use either a general "mass" code or if surgeon is pretty sure the mass is a lipoma, you can bill one of the the D17.x codes. Payers understand the process. They understand that there is likely to be an unspecified initial diagnosis code and final, correct by pathology diagnosis code for the surgery. I taught my surgeons to use "mass" unless they were sure of a lipoma. Lady T is absolutely correct: Use of a "Z"-code is appropriate and important if there is history of malignancy, lipoma, or anything else related to the potential diagnosis, such as history of radiation or chemotherapy. I hope this helps to explain the world of coding to your surgeon. This is what I teach my students: There is "surgeon-speak" and there is "coder-speak". Our job is to mesh the two, helping our surgeons along the way. And, yes, your surgeon posed a very good question.
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Can you give me advise on using D48.5 vs D49.2? I am flooded with right and wrong opinions. However, I have all the proof from ICD-10 guidelines and many other help forums that D49.2 and L98.8 are what we are to use. I do not understand why so many dermatology clinics use D48.5 instead of D49.2 and L98.8 if it is incorrect. Especially when the guidelines are given in addition to links and forums stating D48.5 is incorrect if you have not received the pathology report. We have also had a lab tell us that D48.5 is the diagnosis they get more than any other diagnosis code. Thank you for your time and information. I appreciate it more than you know.
 
Hi Brandy
I can give you what I think by viewing details in ICD10 manual. While looking at dx D48.5 Neoplasm of uncertain behavior skin from the breast, anal area and mouth area. But there are dx codes in the of exact care in the body area location which can abuse the Excludes 1 Rules. Cannot use both these dx codes describing same issue when Excludes Rules 1 happens. Uncertain for the provider or doc does a bx but has no idea but wait till lab results come back or looks like other skin ds. he or she has treated. Whereas dx D49. 2 is include bone, soft tissue not just skin as dx D48.5 includes. Dx L98.8 is any skin condition disorders. At times when the providers are treating skin conditions range of things can be noticed on skin writes in his or her documentation. Skin illness adjectives such as red bumps, redness,L53.9 ,R23,3 or D69, swelling R60, dry skin dx L85.3 changes to skin thickening L85.9. You can add some of these dx on to it but you have to keep integral coding in mind, .As long as it is listed in notations and do not want to abuse the Excludes 1 rule. If skin is burned use dx T20 block and how it happened , date of injury, and place too. Sometimes I use the L98.8 as last dx code. Do you know what L73.1 is? Pseudofolliculitis Barbae is when men will shave & get infected facial bumps or rash. I guess ladies can get that on shaved legs . Just a bit of dermatology trivia there:);)
I hope this helps you.
Lady T:)
 
TThivierge said:
Hi Brandy
I can give you what I think by viewing details in ICD10 manual. While looking at dx D48.5 Neoplasm of uncertain behavior skin from the breast, anal area and mouth area. But there are dx codes in the of exact care in the body area location which can abuse the Excludes 1 Rules. Cannot use both these dx codes describing same issue when Excludes Rules 1 happens. Uncertain for the provider or doc does a bx but has no idea but wait till lab results come back or looks like other skin ds. he or she has treated. Whereas dx D49. 2 is include bone, soft tissue not just skin as dx D48.5 includes. Dx L98.8 is any skin condition disorders. At times when the providers are treating skin conditions range of things can be noticed on skin writes in his or her documentation. Skin illness adjectives such as red bumps, redness,L53.9 ,R23,3 or D69, swelling R60, dry skin dx L85.3 changes to skin thickening L85.9. You can add some of these dx on to it but you have to keep integral coding in mind, .As long as it is listed in notations and do not want to abuse the Excludes 1 rule. If skin is burned use dx T20 block and how it happened , date of injury, and place too. Sometimes I use the L98.8 as last dx code. Do you know what L73.1 is? Pseudofolliculitis Barbae is when men will shave & get infected facial bumps or rash. I guess ladies can get that on shaved legs . Just a bit of dermatology trivia there:);)
I hope this helps you.
Lady T:)
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Thank you so very much for your time and advice. I am forever grateful. :)
 
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