Wiki Dermatology Experts

[Rgreen0118]

I have a family physician that is coding procedure 17281 with a diagnosis of 173.81. Can you assign a malignant dx without a path report? He has never done a biopsy. See the following:

Basal cell carcinoma of skin - New Problem (w/u needed) - on the nose and lower lip these lesions will be cryo treated as they are small , new and superficial in nature. If no response to the cryo, recommend we bx for proper diagnosis, and if positive will need to be excised.

173.81: Basal cell carcinoma of other specified sites of skin [/QUOTE]Thanks in advance!

 

[CatchTheWind]

Although others on this forum have argued otherwise, my understanding is that if the doctor makes a clinical diagnosis, based on his observation, that this is a BCC, you can bill it as such.

 

[Deb P]

Without a path report, there's no way to know if they're truly malignant. And your provider seems to be uncertain as well--"If no response to the cryo, recommend we bx for proper diagnosis, and if positive will need to be excised." It's too bad a bx wasn't done.

I would use the pre-malignant lesion codes 17000 for the 1st (nose) + 17003 for the 2nd (lower lip) with dx 238.2 for both codes (neoplasm skin face of uncertain behavior).

Hope this helps. Good luck!

 

[JFoushee12]

Actually, you would need to use 239.2 neoplasm of unspecified nature; you can only use 238.2 neoplasm of uncertain behavior IF you have a pathology report to back it up.. . given that the provider has not biopsied it yet, you would have to go w/239.2.

Hope that helps! Janelle