Wiki Insurance denied 706.8-I code for a pathology

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bbooks

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I code for a pathology group. We have a number of cases that have denied for the diagnosis code of 706.8, sebaceous hyperplasia. In all of these cases, the provider indicated that they weren't sure what the lesion was and wanted to rule out something more dangerous like BCC or SCC. What would you all use as a secondary code for this situation?

I have also posted this question in the pathology section.
 
I would use V76.43, special screening for malignant neoplasms of the skin.
 
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Found this on a ICD-9-CM code look up for 706.8

Source

Disease Synonyms
Absent sebaceous gland activity
Asteatosis cutis
Asteatotic eczema
Dry skin
Hyperplasia of sebaceous gland
Sebaceous gland duct dilatation
Sebaceous gland hyperplasia
Sebaceous hyperplasia
Senile asteatotic eczema
Senile sebaceous gland hyperplasia
Senile xeroderma
Xerosis cutis
Xerosis cutis (dry skin)
Xerosis due to atopic dermatitis
 
bforr said:
I would use V76.43, special screening for malignant neoplasms of the skin.
Click to expand...

Hmmm. I don't know. I don't thing the screening code would be sufficient for the removal of the lesion.

After further research, I think my best option is adding as a secondary code:
796.4 Other abnormal clinical findings

But I'm all ears if someone has any other ideas.
 
Oh, I see. Your original post didn't specify what procedure you were billing. I assumed a pathologist would have the specimen, rather than remove the lesion himself. If you have any abnormal findings, I would say the code you found is fine. If there are no abnormal findings, I think you're stuck with your original dx code.
 
bbooks said:
Hmmm. I don't know. I don't thing the screening code would be sufficient for the removal of the lesion.

After further research, I think my best option is adding as a secondary code:
796.4 Other abnormal clinical findings

But I'm all ears if someone has any other ideas.
Click to expand...

If the path result is the sebaceous hyperplasia for a lesion the provider removed to suspicions for malignancy then use the V71.1 first listed and the result code secondary
 
bforr said:
Oh, I see. Your original post didn't specify what procedure you were billing. I assumed a pathologist would have the specimen, rather than remove the lesion himself. If you have any abnormal findings, I would say the code you found is fine. If there are no abnormal findings, I think you're stuck with your original dx code.
Click to expand...

Yes, I should have been more specific. I am coding for the pathologist who diagnosed the lesion but did not remove the lesion.

In pathology coding, one always codes the pathological diagnoses (which was 706.8), unless there is no pathological diagnoses available (such as normal findings on pathology), and in that case, one would code the indication for the procedure - the signs, symptoms.
 
mitchellde said:
If the path result is the sebaceous hyperplasia for a lesion the provider removed to suspicions for malignancy then use the V71.1 first listed and the result code secondary
Click to expand...

Thanks for the tip, Debra! The only thing I would do differently is to use the V71.1 as a secondary code. In pathology coding, the pathological diagnosis is always first. I wasn't originally clear that I was coding for pathology.
 
mitchellde said:
The V71.1 is first only allowed it cannot be secondary.
Click to expand...

Surgical pathology coding seems to be the "odd duck" in the coding world. :) V-codes are almost always secondary when coding for pathology. There are a few exceptions.
 
I found a solution! I consulted with our dematopathologists who indicate that when they use the term "sebaceous hyperplasia" as a pathological diagnosis, it can be considered a benign neoplasm of the skin, 216.x.
 
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