I bill at an Ambulatory Surgery Center. Physician coded diagnosed codes 216.4 (benign neoplasm of scalp and skin of neck), 238.2 (neoplasm os uncertain behavior of skin), 782.0 (disturbance of skin sensation), and 702.0 (actinic keratosis), in that order, for proceudre codes 13132 and 21555-59. Our off site professional coder simply used 701.1 (keratomderma, acquired) which is actually supported by the path report. The pathology report states the tissue is Lichenoid actinic keratosis. Now the insurance company is investigation whether the surgery was cosmetic. If the physician excises a lesion of uncertain behavior, and it turns out to be a benign keratosis. Can this somehow be resolved by submitting a corrected claim, or is the coder dorrect in only using the diagnosis on the op report. "Uncertain behavior" certainly indicates the need for excision even if it turns out to be benign. Must I file an appeal on this, or a correction? Sorry for length but any inout would be appreciated. Thanks!
dianeeo52:
dianeeo52: