I just contacted Don and he was kind enough to allow me to share this....
LESION EXCISION RULES CHANGED MARCH 1ST
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.)
If you would like the complete newletter, please PM me. I can send you the attachment.
I believe this is the Medicare link he's referring to......
http://www.ngsmedicare.com/ngsmedicare/lcd/L27362_active_lcd.htm