Wiki Excision - Path report came back, have questions

[AprilSueMadison]

We performed an excision on a patient expecting it to be Merkel Cell or a Melanocytic Melanoma. It came back as Myeloma.

Reading the pathology report, it looks like my diagnosis code will be 203.00. The patient had a previous history of myeloma, and there was no mention in the record if remission had ever been achieved. We excised this because it presented as a lesion on the skin that was suspicious.

I'm a bit confused on excision though. Based on our LCD guidelines (Florida - First Coast Service Options), this is not going to pay correct? No where on the guidelines does it have the code or grouping for 203.

Is this something we can send notes for later explaining we thought it was something else? Has anyone been in this position? Thoughts?

Thank you!

 

[JesseL]

maybe use the " 173 - other specified malignant neoplasm" codes? Since the 203 codes are for "Malignant Neoplasm Of Lymphatic And Hematopoietic Tissue" not skin? And on the claim under box 19 you can specify what it was? Assuming the excision was subcutaneous.

 

[Amy Pritchett]

My question is where was the biopsy excised from? What site on the body? That will determine the code for the myeloma.

 

[AprilSueMadison]

My question is where was the biopsy excised from? What site on the body? That will determine the code for the myeloma.

This excision was performed on the shoulder.

 

[Amy Pritchett]

Then you would have to use the 203.00 as per ICD-9-CM and the encoder. Unfortunately
Sorry

 

[AprilSueMadison]

Then you would have to use the 203.00 as per ICD-9-CM and the encoder. Unfortunately
Sorry

Yeah, that's what I thought. I can't even think of a way to avoid something like this happening in the future. It presented on the surface of the skin and until this path came back, the doctor and patient were unaware that the Myeloma had recurred.