You should wait for the path report to avoid payer scrutiny.
In case you always use diagnosis code 238.2 (Neoplasm of uncertain behavior of skin) while you're reporting 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) for a biopsy procedure your physician carries out, you're jeopardizing your practice. The key to knowing when ou should use the "uncertain behavior" diagnosis code is knowing what that code descriptor actually means. Follow these expert tips to ensure you're choosing the accurate code, after medical procedure codes lookup, for all your 11100 claims.
Wait For Pathology Before Selecting a Code
When your physician conducts a biopsy you must always wait until the pathology report gets back to you to select the appropriate diagnosis and procedure codes to report after medical procedure codes lookup -- even though this will not always have an impact on the CPT billing codes you will wind up choosing.
Reason: The biopsy specimen's pathology will influence the ICD-9 code you report, however maximum CPT procedure codes are not based on the specimen's results. There are a few CPT codes which are related to particular diagnoses (for instance, excision of benign and malignant lesions), but generally CPT is about what you did; whereas ICD-9 is about the result or the reason for it.
Identify the Meaning Behind 'Uncertain' Codes
Once you report 238.2 as the diagnosis, post medical procedure codes lookup , for a biopsy procedure, you're telling the payer that the pathologist stated in his path report that he was unclear regarding the morphology of the lesion.
Uncertain behavior doesn't imply that the coder is unclear or that the physician considers the lesion looks suspicious but it might be benign. Uncertain behavior actually means that a specimen has been examined by a pathologists and also that the cells are of mixed types.
Source URL :- http://www.supercoder.com/coding-newsletters/my-general-surgery-coding-alert/diagnosis-coding-primer-eliminate-uncertain-behavior-confusion-with-expert-tips-on-2382-use-102930-article
How it works: Uncertain behavior diagnoses are suitable for specimens recognized as hyperplastic (hyperplasia) or precancerous. In case you submit a claim with 238.2 as a diagnosis prior to you have the pathology report back, you might have in fact communicated to the insurer that the patient has a disease process that he doesn't really have or may have but has not yet been established.
Example: Your physician finds an irregular lesion on patient's face. The color and shape troubles him and he doubts the lesion may be malignant, however does not want to completely do away with it owing to its size and location unless it is essential. Thus, he simply takes a biopsy of the skin and subcutaneous tissue (11100) and sends the sample to pathology. On pathological evaluation the pathologist cannot decide if the cells from the lesion are malignant or benign, thus, he allocates the diagnosis of "uncertain behavior." In this case, after medical procedure codes lookup, you would validly report 238.2 as the diagnosis code after getting the pathology report.
In case you always use diagnosis code 238.2 (Neoplasm of uncertain behavior of skin) while you're reporting 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) for a biopsy procedure your physician carries out, you're jeopardizing your practice. The key to knowing when ou should use the "uncertain behavior" diagnosis code is knowing what that code descriptor actually means. Follow these expert tips to ensure you're choosing the accurate code, after medical procedure codes lookup, for all your 11100 claims.
Wait For Pathology Before Selecting a Code
When your physician conducts a biopsy you must always wait until the pathology report gets back to you to select the appropriate diagnosis and procedure codes to report after medical procedure codes lookup -- even though this will not always have an impact on the CPT billing codes you will wind up choosing.
Reason: The biopsy specimen's pathology will influence the ICD-9 code you report, however maximum CPT procedure codes are not based on the specimen's results. There are a few CPT codes which are related to particular diagnoses (for instance, excision of benign and malignant lesions), but generally CPT is about what you did; whereas ICD-9 is about the result or the reason for it.
Identify the Meaning Behind 'Uncertain' Codes
Once you report 238.2 as the diagnosis, post medical procedure codes lookup , for a biopsy procedure, you're telling the payer that the pathologist stated in his path report that he was unclear regarding the morphology of the lesion.
Uncertain behavior doesn't imply that the coder is unclear or that the physician considers the lesion looks suspicious but it might be benign. Uncertain behavior actually means that a specimen has been examined by a pathologists and also that the cells are of mixed types.
Source URL :- http://www.supercoder.com/coding-newsletters/my-general-surgery-coding-alert/diagnosis-coding-primer-eliminate-uncertain-behavior-confusion-with-expert-tips-on-2382-use-102930-article
How it works: Uncertain behavior diagnoses are suitable for specimens recognized as hyperplastic (hyperplasia) or precancerous. In case you submit a claim with 238.2 as a diagnosis prior to you have the pathology report back, you might have in fact communicated to the insurer that the patient has a disease process that he doesn't really have or may have but has not yet been established.
Example: Your physician finds an irregular lesion on patient's face. The color and shape troubles him and he doubts the lesion may be malignant, however does not want to completely do away with it owing to its size and location unless it is essential. Thus, he simply takes a biopsy of the skin and subcutaneous tissue (11100) and sends the sample to pathology. On pathological evaluation the pathologist cannot decide if the cells from the lesion are malignant or benign, thus, he allocates the diagnosis of "uncertain behavior." In this case, after medical procedure codes lookup, you would validly report 238.2 as the diagnosis code after getting the pathology report.
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