Wiki Using correct CPT for Excision of Lesions

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Amber_soucy@yahoo.com

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My surgeon regularly removes skin lesions and as we are trying to remain compliant with our diagnosis coding a question has come up for us. We know that we should not be using a diagnosis code stating a lesion is benign or malignant without pathology showing that it actually is one or the other. However the other problem is that all of the CPT codes that describe removal of lesions specify benign or malignant (11400-11600's). Is the provider supposed to take a guess at what she is removing and code that way before pathology comes back? Or must we wait until path is received to even bill the claim at all if we wish to remain compliant? If anyone can offer assistance it would be greatly appreciated!
 
In order to properly code, you need to wait until the path report comes back. Improper level of coding can cost your clinic money.
 
Agreed that you must wait until path report comes back. It usually takes our office 3 days to receive the path reports back. With meaningful use, I am unsure how waiting to code will work out with reporting.
 
There is a CPT assistant from many years back that instructs that for excisions the claim must be help until pathology is returned, you cannot use any 238.x code unless the path report specifies uncertain behavior, and you cannot use 239.x unless you have a preliminary diagnostic report indicating a tumor or abnormal growth.
 
I searched this forum for a thread which addresses the coding of lesions. (I am a mere student at this point, so please forgive any ignorance) :) This is the exact question I had, Amber. Just a thought.. Instead of waiting, could the excision of a lesion be coded as a biopsy? If not, why? Of course that would be assuming that the excised lesion will be sent to pathology. Any information would be more than greatly appreciated!
Thank you,
Lori
 
A biopsy and an excision are 2 completely different procedures. You are not allowed to under code at any time and that is what you.would be doing if you substituted a biopsy for an excision. Also the coder must code from the documentation and code only what is documented. If an excision is what is documented, then that is what must he coded.
 
That makes sense. Yet in a quiz, when you have a question which reads that a provider is excising a suspicious lesion, do you code it under removal of benign or malignant lesion?
 
If it is multiple choice the answer is neither, if it is fill in the Answer is you hold and wait for the path. You cannot use 238.x dx codes with out a path report. So the dx code is still 709.x but you have no excision code for do not know yet path.
 
Thank you Debra, very much. So are you then saying that if a lesion is not determined malignant, you cannot call it benign?
 
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