Wiki New to Derm billing, question about neoplasm dx's

[andreagail]

Hello everyone,
I have recently acquired the billing for a new dermatologist to our group so I may have a few basic questions along the way.
The doctor sends me encounters that list the diagnosis for a biopsy as uncertain behavior because the pathology has not been completed. I think I should be waiting for the path report to come back before sending the claim. She usually does this only for biopsies, other than that she is pretty knowledgable about derm coding and billing. Any insights into this issue anyone?

 

[mitchellde]

you cannot use the 238.x codes without a path report as those codes indicate the path result of cells of uncertain behavior, they are not for a visual inspection that cannot be determined. A biopsy does not require that you wait for path but you can only use what is known at the time which is usually in the 709.x category. By assigning a 238.x code you are communicating a dx the patient may not have which can have the result of causing hirger premiums for the patient as it will increase their risk.

 

[andreagail]

Thanks for the info.