Wiki Coding neoplasms prior to punch biopsy/pathology results

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Kbuss

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I was working on claims for a patient that one of our providers saw who had a "non healing crusty wound" on his right cheek. She scheduled the patient to come back for a punch biopsy a few days later. The ICD-9 code she selected was a malignant neoplasm code. Well...at this point it is unknown whether this is malignant or benign. After the punch biopsy, pathology confirmed it was malignant and this office visit was coded properly but I am struggling to find the right code ICD-9 for the initial visit. I don't think the unspecified neoplasm codes are appropriate and it was suggested to me to try to find a V-code. I have completely exhausted myself over this. Can anyone lead me in the right direction??

Thank you!!

Kim :confused:
 
Generally I have understood that you would wait for the path report and then code accordingly. I think you would use the malignant code for the biopsy.
 
You are correct and I did wait to review the results from the pathology report and used the appropriate ICD-9 for the procedure. But I need to know what I should be using for the office visit when the patient came in prior to the punch biopsy (these are seperate dates of service).
 
If you filed your claim before the biopsy was available, then I would agree with mitchellde. Since you waited for the path report, you should code to the highest level of specificity. Since you now know it was malignant, you should use that code instead.

I should say that I don't have much experience with this area, so maybe you should wait for someone with more experience to confirm or deny, but I think I'm right.
 
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