239.2 has been used as a valid code for billing to insurance for the 11100 when the Path is not yet back and the billing has to go out to insurance. Up til last week this was no issue. All of a sudden Blue Cross is stating this is no longer a valid diagnosis code and will not accept it. Any insight on this? We checked with our other insurance providers they are all still accepting of this code.
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Wiki denial from PABS for 239.2 11100?!
- Thread starter LBernat7
- Start date
mitchellde
True Blue
239 is the category for neoplasm unspecified. The instruction in the codebook states the term "mass" is not to be interpreted as a neoplasm. The word mass in quotes indicates mass as well as similar terms. AHA coding clinics indicate that this category is acceptable only after a preliminary diagnostic study has been performed such as an ultrasound where the provider indicates the result is a tumor or abnormal growth. The appropriate dx code for a skin lesion is the 709.9 or 709.8. Look in the alpha under lesion, then skin, the code book it directing you to the 709.9. The payers have just now caught up with a correct denial.
Thank you Debra- Interesting you bring up the 709.8 and 709.9 I had my billing and payment manager challenge Blue Cross with those diagnosis in lieu of the 239.2 and 239.9 and they stated they too were unacceptable for payment for the 11100 cpt code. We have a call in to our rep who is a bear to reach as BC just put out a bulletin concerning MOHS and acceptable diagnosis where as the 11100 was part of perhaps she can help shed some light on things. Currently I am just holding for paths before billing.
mitchellde
True Blue
I always think it is better to hold for the path, but the 709 is the only code you can use if you don wait for the path. You cannot use the 239 unless the provider documented a skin tumor or an abnormal growth, and let's be honest, they will not document this. And you cannot use the 238 codes without a path report. I understand the payer regarding the 709 for a shave removal, as that has the appearance of cosmetic but a biopsy should be allowed. However remember a biopsy is a removal of a piece of the lesion and a shave removes the entire visible lesion but to a depth of partial thickness. I have read many a report where a shave is described in the note, but the provider stated I sent the specimen for biopsy, which leaves the coder to chose the incorrect code. If the path returns a benign or normal response the use the V71.1 as your first listed code with the 709 as the secondary.
Thank you for your insight I appreciate it very much, I work with a few Physicians that actually do document abnormal growth in their notes based on the way they do their exams I believe it's the way they have been practicing for over 20 years but I always told them they are only as good as the notes they provide.