Thanks to all for this discussion. Let me re-quote what was documented in medical record.
The medical record documentation by provider states "Nevus simplex on right upper inner eyelid" The coder coded D22111-Melanocytic nevi of right upper eyelid, including canthus and G825-Congenital non-neoplastic nevus
In my opinion, provider did not document with specific detail to validate using code D22111
My intention is to drop D22111 and keep Q825
To be able to validate coding the D22111, I would like to have read from provider that this condition included the canthus (where the two eyelids meet) but provider did not document this. There is not a suitable code in D22 series that says "without canthus" So I am of understanding that this condition always includes the canthus per Icd-10 classification. However, I looked at images online that this condition affects the eyelids and not always including the canthus.
I do not wish to banter this but just want to say, THANK YOU ALL for pitching in and helping me with a decision!
I don't want to beat a dead horse either, but I think you're misunderstanding the classification a little bit here. I do not take the '
including canthus' indication in the code description to mean that the code can only be assigned if the lesion involves the canthus - rather that a lesion of the canthus is included in this code. For comparison, a basal cell carcinoma of the skin of the leg would code to C44.71X which is 'basal cell carcinoma of lower limb,
including hip' which does not mean that this is only for lesions that involve the hip, (then there would be no code for the lesion of just the leg?) but rather that hip lesions would be included in this code. If that were the not the case, then we likewise would have no 'suitable' codes for a leg lesions unless the provider specified that the hip was involved. But ICD-10 is clearly set up to include lesions of the leg other than the hip in this code, as you can confirm in both the alphabetic index and the neoplasm table.
Remember that the code is a classification, not a diagnosis. I think of it like a shelf in a library - that shelf contains books about multiple related topics, and the code identifies that shelf - it's not meant to tell you everything that's in the book itself. Also remember that the coding guidelines instruct us to start in the alphabetic index ("
To select a code in the classification that corresponds to a diagnosis or reason for visit documented in a medical record, first locate the term in the Alphabetic Index, and then verify the code in the Tabular List. Read and be guided by instructional notations that appear in both the Alphabetic Index and the Tabular List.") The alphabetic index should drive you to the code. As mentioned above, 'Nevus NOS' directs the coder to D22 and
Nevus --> Skin --> Eyelid takes us to D22.1-, so this is a correct coding for what is in the record. There would be no need to query a provider for additional information or documentation improvement here because the record is sufficient for coding purposes (whether or not it is clinically sufficient is another question entirely).
Again, don't mean to belabor this, but it's a great discussion point and I learn from these questions too. Thanks and happy auditing!