Wiki Shave BX help

[tlwhlw]

A physician performed 2 seperate shave biopsies with the lab report as follows:

Diagnosis:
A) Skin lesion; right face frontal, shave biopsy
Seborrheic Keratosis, Adenoidal type (measures as 1.0 x 0.8 x 0.1 cm)

B) Skin lesion; right face temporal, shave biopsy;
Seborrheic Keratosis, Adenoidal type
Actinic degeneration (measures as 1.5 x 0.6 x 0.1 cm)

He also included 99213-25 w/dx of 724.3 and dictated appropriately. I just want to double check how to code the shave biopsies. Would this be correct:

A) 11312, 702.19, 698.9, 780.96
B) 11313, 702.19, 698.9, 780.96

He indicated in his dictation 698.9 (itching) and 780.96 (pain).

Is there a modifier I need to include for the shave biopsies? Help!!?? and Thank you!!

 

[sbicknell]

For shaves you code based on the longest or largest measurement. Do not add the length or width together and do not add the sizes of the 2 shaves together

shave #1
measures as 1.0 x 0.8 x 0.1 cm
code 13111
Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm

shave #2
measures as 1.5 x 0.6 x 0.1 cm
code 13112
Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm

You should use mod -59. Here is a brief paste from CMS

Use modifier 59 to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. This may represent:
 A different session or patient encounter.
 Different procedure or surgery.
 Different site or organ system.
 Separate incision/excision.
 Separate lesion.
 Separate injury (or area of injury in extensive injuries).

 

[Ksumansky]

I do agree with using codes 13111 and 13112 but I am not sure if i am on the right page or not, I was looking on my CCI edits and did not see a need for mod 59 for codes 13111 and 13112. Do you have to put it on a claim even if the codes do not appear on the edits list?

 

[sbicknell]

agree, probably not needed. I was thinking since both were done on the face (my brain lapse).

The -59 would be more approriate if you ended up with 13111 and 13111

 

[muthershyp]

There is a great article in the American Acadamy of Dermatology's newsletter for coders regarding how to code biopsies. The newsletter in entitled "Derm Coding Consult" and is available online:

hhtp://www.aad.org/members/publications/consult.html

Basically the article explains that it doesn't matter what technique is used; the focus should be the intent. If the intent is to submit for biopsy to determine the nature of the tissue, the codes will be 11100 and 11101. If the intent is to remove the lesion, then coding by technique is in order even though tissue may be submitted for biopsy.