Wiki Noridian - Benign Lesion Removal LCD

[arozance27]

Coding medical necessity for benign skin lesions for Medicare. LCD L34233 (Noridian) Group 2 - List III codes

Medicare will consider the removal of benign skin lesions as medically necessary, and not cosmetic, if one or
more of the following conditions is present and clearly documented in the medical record:
A. The lesion has one or more of the following characteristics:
1. bleeding
2. intense itching
3. pain

When a dysplastic nevus with moderate atypia is removed via excision, wondering what would be most appropiate code if any from group III when no symptoms are present. Thoughts?

 

[ellzeycoding]

Atypical dysplastic nevus is coded as D48.5 in ICD-10.

 

[mitchellde]

Atypical dysplastic nevus is coded as D48.5 in ICD-10.

I agree, if you have a pathology report that states this is a dysplastic atypical Nevus, then it is not benign and should not be coded as benign, nor is it coded as malignant. This is when uncertain behavior is the correct choice

 

[arozance27]

This is where I don't follow.

In ICD-10 Index:

Nevus - Dysplastic: Direct to - see Neoplasm, skin, benign.

Under series D22 - includes atypical nevus.

How are you guiding to D48?

 

[torresreb]

How are you guiding to D48?

I believe you've indicated that this was "atypia" .. thus the look up that directed to D48 ...

 

[kheimerman]

Nevus ICD-10 conundrum

I also am confused how you are getting D48.x from atypia, dyspastic or nevus.

In my ICD-10 index:

Under atypia there is nothing, under atypical: see condition. Under condition: see disease

Under dysplastic: nothing. Under dysplasia (see also anomaly)- indented to skin: L98.8.
Under anomaly (see also from dysplasia)- indented to skin (appendage): Q82.9

Under nevus:
There is nothing for atypical(l),
Dysplastic: see Neoplasm, skin, benign. Those are all D23.x codes except for site specific female and male genital codes.
Nevus: indented to skin: D22.9 with all the anatomical areas listed below and all D22.x codes.

Under D22.x in the tabular listings (Melanocytic nevi) the INCLUDES says: atypical nevus, blue hairy pigmented nevus, nevus NOS and then lists all the different areas with corresponding 5th character codes.

Interestingly though I noticed under the Index for nevus there was a sub-listing indention to Blue: and it directs to neoplasm, skin, benign which are the D23.x codes.... so only if it is a blue hairy pigmented nevus it codes to D22.x?

Trying to differentiate between it should be D22.x Melanocytic nevus versus D23.x Benign neoplasm nevus.... it it the pigmentation? (melanocytic?)

Anyone?

 

[ellzeycoding]

Here is a good article that explains it.

http://digitaleditions.walsworthprintgroup.com/publication/?i=299443&article_id=2465022&view=articleBrowser&ver=html5#{%22issue_id%22:299443,%22view%22:%22articleBrowser%22,%22article_id%22:%222465022%22}