heatherwinters
Expert
Has anyone had a chance to review the new LCD from NGS on Lesion Removals. According to them, pathology does not determine code selection. I was always taught to wait for the pathology report to come back before I code lesion removals. See this excerpt from a recent article from G. John Verhovsek, MA, CPC located at http://www.surgistrategies.com/articles/skin-lesion-coding.html
However, now I have received the following from NGS stating that pathology does not change procedure performed. Tell me, if we do not have a pathology report, how do we know if lesion was benign or malignant and which codes to select??
"Because CPT classifies lesions as either “benign” or “malignant,” you should always wait for the pathology report before selecting CPT or ICD-9 to describe the excised lesion(s). There is a single exception to this rule: If the surgeon performs a re-excision to obtain clear margins at a subsequent operative session, you may report automatically the same malignant diagnosis you linked to the initial excision. This is true even if the pathology report on the second excision returns benign, because the original reason for the re-excision was malignancy."
However, now I have received the following from NGS stating that pathology does not change procedure performed. Tell me, if we do not have a pathology report, how do we know if lesion was benign or malignant and which codes to select??
Subject: Part B News: Medicare Providers Who Bill for Removal of Lesions (Article Revision)
Revised Coding Information for Removal of Benign Skin Lesions
This article replaces the Listserv article distributed on April 13, 2009. These instructions apply to providers who submit Part B claims. Additional guidelines applicable to Part A claims will be provided in a separate notice.
Recent medical review of documentation has indicated an educational need with regards to the reporting of removal of lesions. The local coverage determination (LCD) and coding article (SIA) for Removal of Benign Skin Lesions (L27362/A47397) will be revised on June 1, 2009 and will include revised guidelines.
If a benign skin lesion excision was performed, report the applicable CPT code, even if final pathology demonstrates a malignant or carcinoma in situ diagnosis for the lesion removed. The final pathology does not change the CPT code of the procedure performed. An ambiguous but low suspicion lesion would be reported as a benign lesion (codes 11400-11446) reflecting the procedure that was performed. A moderate-to-high suspicion lesion may be reported as a malignancy (codes 11600-11646), if the appropriate excision was performed.
To report removal of lesions of uncertain morphology, prior to identification of the specimen, report ICD-9-CM code 239.2 (neoplasms of unspecified nature, bone, soft tissue, and skin), or ICD-9-CM code 709.9 (unspecified disorder of skin and subcutaneous tissue) since proper coding requires the highest level of diagnosis known at the time the procedure was performed.” (ICD-9-CM code 709.9 will be added to the list of payable diagnoses in the LCD.)
Providers who submit claims to Medicare for excision of lesions should become familiar with the revised LCD which became effective March 1, 2009 and with future revisions.
Thank you,
National Government Services, Inc.
Corporate Communications
Revised Coding Information for Removal of Benign Skin Lesions
This article replaces the Listserv article distributed on April 13, 2009. These instructions apply to providers who submit Part B claims. Additional guidelines applicable to Part A claims will be provided in a separate notice.
Recent medical review of documentation has indicated an educational need with regards to the reporting of removal of lesions. The local coverage determination (LCD) and coding article (SIA) for Removal of Benign Skin Lesions (L27362/A47397) will be revised on June 1, 2009 and will include revised guidelines.
If a benign skin lesion excision was performed, report the applicable CPT code, even if final pathology demonstrates a malignant or carcinoma in situ diagnosis for the lesion removed. The final pathology does not change the CPT code of the procedure performed. An ambiguous but low suspicion lesion would be reported as a benign lesion (codes 11400-11446) reflecting the procedure that was performed. A moderate-to-high suspicion lesion may be reported as a malignancy (codes 11600-11646), if the appropriate excision was performed.
To report removal of lesions of uncertain morphology, prior to identification of the specimen, report ICD-9-CM code 239.2 (neoplasms of unspecified nature, bone, soft tissue, and skin), or ICD-9-CM code 709.9 (unspecified disorder of skin and subcutaneous tissue) since proper coding requires the highest level of diagnosis known at the time the procedure was performed.” (ICD-9-CM code 709.9 will be added to the list of payable diagnoses in the LCD.)
Providers who submit claims to Medicare for excision of lesions should become familiar with the revised LCD which became effective March 1, 2009 and with future revisions.
Thank you,
National Government Services, Inc.
Corporate Communications
