Wiki lesion

[drweberhawkley]

My question is when a physician excised a malignant lesion than the has to do a re excision and path comes back as non-malignant, would the coder use the benign or malignant CPT code?

 

[TThivierge]

DrWeber
You go by the pathologist reported after tested specimen or lab results. I d use benign dx code in setting described above if non malignant
When I first starting medical coding education about 20 years ago there is true story about a doctor put Cancer on patient s dx code to get more money from insurance company. The EOB came to the home in which the female patient read & then killed herself cause she thought she had Cancer. The doctor was sued BIG time because the patient did not have this illness he was trying to get more funds
I hope helped you
Lady T

 

[catherinetinkey@entmedicalservices.org]

This is from AAPC online, above answers holds true for initial excision but not for re-excision.

Answer: Regardless of whether a skin excision is the initial procedure or a repeat excision, you should code a malignant lesion according to the size and margin noted in the medical record.

If the dimensions fit, you should use 11600 (Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.5 cm or less) again, because you state that the re-excision is because the margins were not clear and not because of some issue related to the scar or repair.

Add modifier: Because 11600 has a 10-day global period and the re-excision takes place within a week, you’ll need to append modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period) to the second procedure. You should append modifier 58 when a procedure or service is planned or anticipated at the time of the original procedure (staged), is more extensive than the original procedure (which is the case in this scenario), or represents therapy following a surgical procedure.

Tip: You need not return the patient to the operating room to report modifier 58. Also, be sure to use the same malignant diagnosis again even if the most recent excision shows no cancer cells in the specimen, which is common in these re-excision situations.