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Wiki Dx codes for 11100
- Thread starter cohela
- Start date
teresabug
Expert
this is a skin biopsy code. The reportable dx codes are in the hundreds. Your providers should be telling you to hold any skin biopsy, excision, shave claims until the path report is done. You could have a benign neoplasm, malig neoplasm, lipoma, basal cell or squamous cell carcinoma, etc etc etc.....
mitchellde
True Blue
A biopsy does not need to be held for path report, however without a path report you cannot code benign, malignant, or uncertain behavior(238.2) dx codes. So your choices are to wait for the path or use the symptom code such as 709.9. If the path result is neither malignant or uncertain behavior, then you use V71.1 as the the first listed dx code.
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teresabug
Expert
why wouldnt it be? Isn't it better Deborah to code to the highest level of specificity? What if the dr coded it as a benign neoplasm and it came back as melanoma? (its happened.)
This affects reporting, pt history, insurance apps for pre-existing etc correct?
This affects reporting, pt history, insurance apps for pre-existing etc correct?
mitchellde
True Blue
I am not sure what your question is Theresa. A biopsy does not have to be held for path, I think it is better but it is not required. We do not code from what a provider has coded but from what is documented. I have observed numerous providers using incorrect codes such as benign and uncertain behavior, however these codes are not supported by the documentation so they should not be coded as the provider has indicated by code but coded as indicated by documentation, usually the documentation supports a skin lesion, the choice is to code it as a 709.9 or wait for the path report, I personally choose to wait for path. An excision cannot be coded until path has been rendered.
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teresabug
Expert
hear me out: I audited a chart today. Dr did 2 shaves on 2 lesions. One came back as seb k and the other lentigo. He coded them as 709.9 and didn't wait for the path to come in. 709.9 is an unspec code and I always prompt dr's to be as specific as possible.
mitchellde
True Blue
I am agreeing with you, however while I feel it is best to wait for the path report, the only time it is required is for excisions. 709.9 is unspecified and depending on how it is documented I might use that code or I may use 709.8 for other specified. It just depends on the documentation. I realize that most shaves will not be paid using 709.9 or 709.8 which is why I encourage all my students to hold them for path. But I never use the providers codes unless it happens to be the correct one per the documentation.
As far as the audit goes, it is perfectly acceptable to use the 709.9 as the dx code and submit for payment. This is an acceptable use of unspecified since there was no way for the provider to know what the result would be. It is not a problem to start with a symptom or vague diagnosis, and lead into the more definitive at a future encounter. This does not hurt the patient record at all.
As far as the audit goes, it is perfectly acceptable to use the 709.9 as the dx code and submit for payment. This is an acceptable use of unspecified since there was no way for the provider to know what the result would be. It is not a problem to start with a symptom or vague diagnosis, and lead into the more definitive at a future encounter. This does not hurt the patient record at all.