Wiki Neoplasm of Uncertain Behavior

[SWsibemom]

When a biopsy is performed and the dermatologist reads their own slides before sending it to pathology can the dermatologist use D48.5 on the requisition or is unspecified behavior or signs and symptoms more appropriate? I work for the pathologist and have found inconsistencies with how the local doctors use neoplasm of uncertain behavior on the requisition and I am being asked to educate them as to the use of this Dx.

 

[thomas7331]

Whether or not a code is correct will depend on the content of the patient's medical record, so without seeing the record and reviewing the diagnosis that the physician has made, there is no way to say if a code on a requisition is appropriate or not. The coding guidelines state that the criteria for reporting a diagnosis code is that the medical record contains the physician's statement that the condition exists at the time of the encounter, so if the dermatologist has reviewed the slide and documented in the record a diagnosis of 'neoplasm of uncertain behavior', then that would be the appropriate code to report the encounter. But you're correct that D48.5 is used inconsistently and incorrectly by providers. Per ICD-10 guidelines, this code is meant for reporting a neoplasm that has inconclusive pathology, and not for use to describe a lesion for which a pathology report has not been made, which is how it is often used by dermatologists.

In one facility where I worked, incorrect coding by physicians on requisitions was an ongoing problem since physicians in small practices are often untrained in ICD-10 guidelines and may not employ certified coders. Due to this, the facility did not accept requisitions with just an ICD-10 code, but instead required that the physician state the diagnosis itself so that the facility coders could choose the appropriate code.

 

[SWsibemom]

Whether or not a code is correct will depend on the content of the patient's medical record, so without seeing the record and reviewing the diagnosis that the physician has made, there is no way to say if a code on a requisition is appropriate or not. The coding guidelines state that the criteria for reporting a diagnosis code is that the medical record contains the physician's statement that the condition exists at the time of the encounter, so if the dermatologist has reviewed the slide and documented in the record a diagnosis of 'neoplasm of uncertain behavior', then that would be the appropriate code to report the encounter. But you're correct that D48.5 is used inconsistently and incorrectly by providers. Per ICD-10 guidelines, this code is meant for reporting a neoplasm that has inconclusive pathology, and not for use to describe a lesion for which a pathology report has not been made, which is how it is often used by dermatologists.

In one facility where I worked, incorrect coding by physicians on requisitions was an ongoing problem since physicians in small practices are often untrained in ICD-10 guidelines and may not employ certified coders. Due to this, the facility did not accept requisitions with just an ICD-10 code, but instead required that the physician state the diagnosis itself so that the facility coders could choose the appropriate code.

Since we don't have access to the medical records, we won't know if documentation supports that Dx. This is my quandary. Sometimes the requisition has differential diagnoses of this vs that, but then has the Dx code of D48.5, which is not acceptable since D48.5 would not be used in those circumstances. If they read the slide and are not sure of the Dx and are sending it for a pathologist to read, wouldn't unspecified behavior be more appropriate? I am trying to figure out how to tell them when uncertain vs unspecified is used and wrap my own head around it as well. I know uncertain behavior requires a histologic confirmation and documentation in the records. Unspecified behavior would be used in this circumstance, right? We are working on putting a policy in place like what your facility has as to what we can accept on the requisition and educate the providers as to the correct usage.

Thank you for your response.

 

[danachock]

Hi SWsibemom,
I may be able to offer some guidance on this. I just had the opportunity to watch one of our AAPC webinars a few days ago that actually touched on this very topic "Anatomy and Pathophysiology of Neoplasms" by Sheri Poe Bernard, CPC, CRC, CDEO, CCS-P that may offer some guidance that I wanted to share.
Yes, the dermatology providers do utilize the microscope, but I cannot validate that it is utilized every single time a biopsy or otherwise is performed on a patient.
Per my handwritten notes "uncertain behavior" was discussed to explain that "Categories D37-D44 and D48 classify by site the neoplasms of uncertain behavior - this requires the histologic confirmation (use of microscope) on whether the neoplasm is malignant or benign simply cannot be made."
Again, as I stated earlier - I am unsure if microscopic is performed on every specimen acquired by a dermatologist or not prior to submitting the specimen to the pathology department for review, so I am unsure whether or not it is appropriate for them to assign D37-D44 and D48 to a specimen unless they have personally reviewed it microscopically first before sending it.
If in the event that it is not reviewed by a microscope by the dermatologist prior to being sent to the pathology department for review they would want to utilize the unspecified behavior diagnosis code because we would want to reserve those codes listed above (D37-D44 along with D48) for microscopic evaluation first.
Hopefully some of this information may be of value for you.
Have a great evening and thank you for listening,
Dana Chock
Coding Specialist 3 - Pathology & Coding Analyst

 

[SWsibemom]

Hi SWsibemom,
I may be able to offer some guidance on this. I just had the opportunity to watch one of our AAPC webinars a few days ago that actually touched on this very topic "Anatomy and Pathophysiology of Neoplasms" by Sheri Poe Bernard, CPC, CRC, CDEO, CCS-P that may offer some guidance that I wanted to share.
Yes, the dermatology providers do utilize the microscope, but I cannot validate that it is utilized every single time a biopsy or otherwise is performed on a patient.
Per my handwritten notes "uncertain behavior" was discussed to explain that "Categories D37-D44 and D48 classify by site the neoplasms of uncertain behavior - this requires the histologic confirmation (use of microscope) on whether the neoplasm is malignant or benign simply cannot be made."
Again, as I stated earlier - I am unsure if microscopic is performed on every specimen acquired by a dermatologist or not prior to submitting the specimen to the pathology department for review, so I am unsure whether or not it is appropriate for them to assign D37-D44 and D48 to a specimen unless they have personally reviewed it microscopically first before sending it.
If in the event that it is not reviewed by a microscope by the dermatologist prior to being sent to the pathology department for review they would want to utilize the unspecified behavior diagnosis code because we would want to reserve those codes listed above (D37-D44 along with D48) for microscopic evaluation first.
Hopefully some of this information may be of value for you.
Have a great evening and thank you for listening,
Dana Chock
Coding Specialist 3 - Pathology & Coding Analyst

Dana, I will watch the webinar as well. Thank you for the response and explanation.