Wiki ICD-9 Assignment - Pathology Audit/Coding

[JGGBALLEN]

Thank you in advance for any assistance provided.

I am performing a physician chart review of pathology.

Provider submitted 88302 / dx 550.90

Clinical Information:
Rt inguinal hernia
Repair Rt inguinal hernia with mesh

Gross Description:
RT LIPOMA OF CORD AND HERNIA SAC: Received in formlin is a fragment of yellow red adipose tissue measuring 3.2x1.5x0.5cm. Also received in the same container is
a 3.7x1.4x0.5 cm fragment od pint tan smooth and shin tissue. Sectioning of both fragments reveals an unremarkable cut surface. Representative sections from each are submitted in one cassette.

Diagnosis:
SOFT TISSUE, RIGHT CODE AND HERNIA SAC, EXCISION.
-Mature fibroadipose tissue consistent with lipoma
-Mesothelial lined fibroconnective tissue consistent with hernia sac.

I agree with 88302, Level II Surgical Pathology, gross & miscroscopic exam, Hernia sac, confirm ID and absence of disease. Adding modifier -26
However, ICD-9 215.6 (lipoma; inguinal region) seems more appropriate as a pathology primary dx. Do you agree?
Additionally, I was told that clinical findings (Rt inguinal hernia) should not be coded for pathology charge capture.
IS that correct? Should they NOT be coded or are they not NECESSARY to code?
215.6
550.90
Thnx again

 

[bbooks]

Lipoma of the cord would be 214.4 and one could argue that the pathologist could have charged 88304 for that. If the hernia sac was part of the path specimen (seems it was) 550.90 seems an appropriate diagnosis code. I'm not quite sure about the second specimen "3.7x1.4x0.5 cm fragment od pint tan smooth and shin tissue." Are there still spelling issues here? It was read out as consistent with a hernia sac.

 

[JGGBALLEN]

Thank you very much
Just to clarify...I will code 214.4 (spermatic cord) as primary.
However, are secondary and tertiary I9 codes also "required" from the clinical findings?
I do not feel it is wrong to use, provides a clearer story, but I was told it (dx from clinical findings) should not be used.
Also, I see your point with the possible use of 88304 (soft tissue lipoma). I thought about that, but refrained. I felt the lipoma dx was determined after specimen exam. Is that not a correct assessment?

 

[bbooks]

I read through Padget's but couldn't find anything specifically related to submitting a cord lipoma with a hernia. A little Internet digging did find this opinion: http://www.pathpedia.com/Updates/Update.aspx?e71bba3c-26fd-40b7-ae36-6de7d72c70d0
Scroll down to the bottom to read the reference to a cord lipoma with a hernia. This author suggests that the case could be upcoded to 88304 because of the submission of the lipoma with the hernia sac.

I have nothing specifically written to back me up on this, but since the hernia sac was submitted, one could include 599.90 with 214.4. If the case was of a hernia repair and just the lipoma was submitted, then I would include the diagnosis code for just the lipoma.

 

[JGGBALLEN]

Thank you! Thank you!
Greatly appreciated and great reference site...save to my desktop.
My last question is this...in the above example the report notes "GROSS DESCRIPTION"
When I review Encode Pro and other internet searches including Associaion of Directors of Anatomic and Surgical Pathology they imply good surgical pathology documentation should reflect a series of items. One in particular was noting both GROSS and MICROSCOPIC DESCRIPTION for
88302 - 83309. That said, with the heading stating "GROSS DESCRIPTION" is the additional info noted considered "MICROSCOPIC DESCRIPTION" EX: (Received in formlin is a fragment of yellow red adipose tissue measuring 3.2x1.5x0.5cm) and (Also received in the same container is
a 3.7x1.4x0.5 cm fragment of pink tan smooth and shin tissue).
Or am I taking the Gross Description too literal?

 

[JGGBALLEN]

Hello and thank you to anyone that replys

I have been asked by a physician within a facility lab if there are addt'l codes to bill for intraop consult services provided after working hours.

I am leaning to reply with no, but I am a novice within this speciality.

Please advise.

thanks again

 

[Zina]

modifier

We currently have a claim like this pending at Medicare for a modifier. They won't tell us which one, just that we need one. I can't find anything in the Medicare manual. Any ideas?