I am needing something in writting about how and when to bill for skin neoplasm. My practice likes to use code 238.2 "Neoplasm of uncertain behavior" when removing a skin lesion and want me to bill it that way before the pathology report is back with the actual diagnosis. My problem with this is that the stigma of "Neoplasm" of any kind is not supposed to be given to a patient unless it is actually a neoplasm. My practice likes to then go back to the original claim and change the diagnosis once the pathology report is in and send corrected claims with the new diagnosis code. I think this is incorrect coding practice but don't know where to find it in writing to give to my doc. Any help would be greatly appreciated. Thanks Missy
-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki Billing for Skin
- Thread starter jeffriesm
- Start date
mitchellde
True Blue
In the ICD-9 book at the beginning of the uncertain behavior sub section you will find what you are looking for I forget exactly how it is worded but it tells you these are histologic codes which means they can be assigned only with pathology.
If you are performing an excision you must wait for path as the procedure codes are only benign or malignant excisions which you cannot guess at.
If you performed a biopsy or a shave you are not required to wait for path but you cannot code a neoplasm either so you use the 709.x code
Remember the dx code belongs to the patient and we must be correct for the PATIENT'S diagnosis
If you are performing an excision you must wait for path as the procedure codes are only benign or malignant excisions which you cannot guess at.
If you performed a biopsy or a shave you are not required to wait for path but you cannot code a neoplasm either so you use the 709.x code
Remember the dx code belongs to the patient and we must be correct for the PATIENT'S diagnosis
lbpeterson
Contributor
Missy, that seems like so much work for you, coding initial then coding/submitting corrected claim after pathology report!
I code excisions/lesion removals for my physician group, I will not as a certified coder and certified auditor, code lesion removals without the pathology results. How can your practice ethically bill a patient with "neoplasm of unspecified behavior" when your path results two days later state "verruca vulgaris". That is incorrect coding.
Also, submitted corrected claims for each excision/lesion removal will send red flags to your payers.
Hope this helps!
I code excisions/lesion removals for my physician group, I will not as a certified coder and certified auditor, code lesion removals without the pathology results. How can your practice ethically bill a patient with "neoplasm of unspecified behavior" when your path results two days later state "verruca vulgaris". That is incorrect coding.
Also, submitted corrected claims for each excision/lesion removal will send red flags to your payers.
Hope this helps!