1. Julie Gade
   Posted 1 year ago #
   

   Dr. does shave remaoval of lesion and submits to pathology and returns as malignant as squamous cell carcinoma in situ. Billed Medicare CPT 113xx and diagnosis with 232.x. Medicare denies stating removal policy lists shaving code 11300 through 11313 as only covered with benign diagnosis codes. How should this be coded then? Any suggestions?

2. SuperCoder
   Posted 1 year ago #
   

   Whenever a specimen after removal of a skin lesion is sent to pathlogy for evaluation, then physician should wait for getting path evaluation results, so that both the services can be billed as per the findings.

   Since the finding is malignant, so the CPT code for the first procedure should be determined by the finidings. So, here we can code in the range 11600-11602 as per the size of the malignant lesion and per anatomical site. ICD range of 232.5-232.7 goes approriately with this range.

3. Julie Gade
   Posted 1 year ago #
   

   I strongly hesitate to code this situation as a malignant excision, as the documentation specifically describes a horizontal slicing to remove a dermal lesion without a full thickness excision. I do not see how one can code a procedure that truly was not done. Where would I find documentation that instructs what you are suggesting?

   To quote information directly from Supercoder:

   "To differentiate between shaving (CPT codes 11300-11313) and excision (CPT codes 11400-11646), look at the removal's depth. Technically, any time the physician removes skin tissue, they are performing an "excision." For coding purposes, however, CPT narrowly defines an excision as involving "full-thickness (through the dermis) removal of a lesion." Shaving, in contrast, involves "sharp removal ... without a full-thickness dermal excision."

   Physician Responsibility
   After local anesthesia is administered, the physician holds the blade (a No. 15, for example) or DermaBlade, horizontal to the skin and moves it across a single lesion with a sawing motion. Shaving usually extends to the middle dermis without disturbing the subcutaneous tissue, followed by cautrey to control bleeding, without any suturing. In some cases, the physician may remove the raised portion of a benign lesion and allow additional lesion tissue to persist in the dermis.

   Excision, in contrast, usually involves holding the blade perpendicular to (and thus cutting through) the skin to remove the lesion at a greater depth. In these cases, the physician always intends to remove the entire lesion to the greatest necessary depth.

   Again, where would I find documentation that instructs what you are suggesting? Thank you.

4. Sharon LaCross
   Posted 5 months ago #
   

   Dr. Bills 11602 exc tr with dx 173.6 then 17000 dest lesions dx 702.0 and 17003 modifer 59 was used on sec proc 17000 and was rejected by medicare for modifier-why was this billed incorrectly?

5. SuperCoder
   Posted 5 months ago #
   

   To Julie Gade: Absolutely agree with you but we should not always go by guidelines which may not cover all aspects of scenario, may be very very close to 100% but not 100%. The context you raised the code you analyzed and suggested is correct, but with one exception:
   If the physician highly suspects it as carcinoma in situ, so he did horizontal slicing..usually not followed in carcinomatous condition, if the lesion is in pre-cancerous condition, as is above.
   Ref:
   1. Physiology and anatomy :
   http://www.wisegeek.com/what-is-carcinoma-in-situ.htm
   2. Coding complexity:
   http://www.skincentre.com/skin_cancer/Squamous_Cell_Carcinoma/Published_Literature/
   ====================================================================================
   Sharon LaCross
   Please notice thoroughly the documentation of the procedure, wherein 17000 is considered part parcel of the major procedure,i.e., 11602, so normally written off.

6. Julie Gade
   Posted 5 months ago #
   

   Mutually exclusive edit...

   Code 11602 is a column 2 code for 17000, but a modifier is allowed in order to differentiate between the services provided.

   *Use modifier with code 11602.

   Put modifier 59 on 11602

7. SuperCoder
   Posted 5 months ago #
   

   Yes Julie, I agree with you.. Tecnnically you are correct.
   Denial even with a 59 modifier has been only my practical experience over the years.

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