Wiki AK dx vs CA for skin excision codes

[kheimerman]

When we have a patient with a lesion that looks like a skin cancer and we excise it for instance- 17280 to 17286 code range, but when the histopathology comes back it was an actinic keratosis, which is a PREMALIGNANT Lesion, does that mean we need to change the CPT code range to 11310 to 11313 code range? That is what I thought since AK are PRE-malignant, not cancer; however our benign lesion LCD does not allow for ICD-10 L57.0 (actinic keratosis). What do you all do in this situation? Thanks for any input!

 

[ellzeycoding]

If it was not biopsied prior to path, and you had no idea what it was, code with D49.2 to show medical necessity. Most carriers will have this as a code to support medical necessity.

Always hold for path, so you know whether to bill benign vs. malignant. excision.

In this case bill benign excision code with D49.2 and should be fine.

Note: You mentioned 17280-17286 which are destruction codes, not excision codes like in the title of your question.

Then you mention changing to 11300 codes which aren't excisions either. They are shave removals.

Benign excision codes are in the 114XX series.

 

[kheimerman]

If it was not biopsied prior to path, and you had no idea what it was, code with D49.2 to show medical necessity. Most carriers will have this as a code to support medical necessity.

Always hold for path, so you know whether to bill benign vs. malignant. excision.

In this case bill benign excision code with D49.2 and should be fine.

Note: You mentioned 17280-17286 which are destruction codes, not excision codes like in the title of your question.

Then you mention changing to 11300 codes which aren't excisions either. They are shave removals.

Benign excision codes are in the 114XX series.

Please excuse my nomenclature. You are correct. I should have said shave removal and destruction/surgical curettement to describe the code ranges; however I do not understand your answer to my query. You say if it was not biopsied prior to path..? I assume you mean if the lesion was not biopsied prior to shave removal then it can be coded as D49.2 to show medical necessity, but in the next sentence advise to hold for pathology so you will know which CPT code range to use, and use the D49.2 with a benign CPT code. We always wait for the histopathology result to code, so I will know which CPT code to use. I would not be comfortable coding a D49.2 when I have a definitive histopath result of L57.0. I have a benign CPT code with a pre-malignant (benign) ICD-10. Great. The problem is L57.0 is not on the benign lesion LCD. Is it acceptable to use a D49.2 once you have the histopath result or do I just fight a denial on the back side of the claim every time this happens? Thanks for clarifying!

 

[ellzeycoding]

Yes, meant to say if it was not biopsied prior to excision or shave.

You should always hold for path so know whether to bill the benign vs. malignant excision codes.

If you didn't biopsy it prior, and the provider could not specify what the lesion was, D49.2 shows medical necessity. You can code the final results, but sometimes the final result is not covered for that procedure. Since the provider couldn't specify what it was, and no biopsy was taken, D49.2 will allow it to get paid. Most carrier's LCDs usally have D49.2 (Neoplasm of unspecified behavior) as a covered DX to show medical necessity.

Shave removals don't require path confirmation. So you can bill them with D49.2 as well.

Or you can code the final path, as long as it's covered.

Alternatively, if the provider that reasonable certainty that a lesion was a certain diagnosis, and shaved or excised, and it came back as that, but that condition is not covered, it may be considered medically unnecessary or cosmetic and the patient may be responsible for the cost of the procedure. As long as they were notified, signed an ABN, or equivalent form for commercial carriers.

 

[kheimerman]

Shave removal dx

Thank you so much for clarifying. I didn't realize path wasn't required for shave removals and we do a lot of them in our clinic. Using D49.2 basically as a rule out code makes sense on those. Thank you so much for that info. Our providers are pretty spot on, and usually the path agrees with their clinical diagnosis, but on occasion we get surprised and it seems those are the ones that have benign non-LCD diagnoses of course!