Wiki Dermatology questions

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jschmidtkarls@comcast.net

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Two questions if there is anyone out there who codes for Derm.that we keep going round and round on.
1.) When coding for MediCare does a code for SCC in situ roll over to a V10.83 after three months of being treated?

2.) When coding for X procedures (like BX or EXCs) on same visit, do you charge post in the order of the PRs and Path report or in the order of the most significant/serious finding?
 
The answer to number 1.... Once excision of the in situ neoplasm is complete then the neoplasm is now history of. So the next encounter after the excision is the V10.xx code. When the neoplasm is in situ then there are no invasive components yet, that is what makes it in situ, so excision is definitive therapy and they know it is all gone.

Number 2... I have to say I am a little confused by the question. If you have a dx and excision on the same day and of course they must be two different areas, as you cannot bill for both of the same lesion, the dx code that is first listed should match to the first listed procedure code as a general rule. You do not code the symptoms, only the definitive from the path report. I hope that is the answer you were wanting.
 
I'm in agreement with Debra on both questions.

#1. SCC in situ (232.?), once treated, becomes V10.83 for follow-up encounters.

#2. I, too, am somewhat confused by this question. A biopsy and excision on the same lesion, same date of service, is billed as excision. A biopsy can only be billed seperately if it is a seperate lesion. Further, and maybe this is the answer to your question, when posting the charges, I don't think they need to be in any specific order. I personally post charges in the order they appear on the superbill, simply to keep myself a little less confused! :)

Hope this helps.

Cindy Blount, CPC-D
 
Just answer # 2

As for Q # 2 ... my colleagues have given you accurate info on when you can code both biopsy and excision on the same DOS (i.e. different lesions).

In general whenever you have two or more CPTs on the same claim, you list them in order of highest RVU value first. With an excision, you may even have a layered or complex repair to code.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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