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11100 with Dx 238.2 or wait for pathology?

Maarit Posted Thu 12th of January, 2012 16:10:48 PM

Is it correct to bill out a skin lesion biopsy with Dx 238.2, when the suspicious characteristics are documented..or should one always wait for the pathology Dx, before sending out the claim?

SuperCoder Answered Thu 12th of January, 2012 19:00:45 PM

238.2 is an "uncertain behavior" code and the pathologist needs to make that determination of uncertain. Neoplasms of uncertain behavior have very specific histology that the pathologist describes. They are not the same as unspecified (which is more appropriate if you’re billing before you have the biopsy results or when the pathology report and physician’s documentation don’t contain enough information to select a more specific code, possibly due to an inadequate specimen).

Deborah Marsh, JD, MA, CPC, CHONC
Coding Institute editor

Maarit Posted Fri 20th of January, 2012 16:58:14 PM

Pathology reads: Junctional nevus with architectural disorder and moderate cytologic
atypia. It is a mole on abdomen. Is this 238.2 or 216.5?
thank you

SuperCoder Answered Mon 23rd of January, 2012 17:19:58 PM

Nevus, skin(junctional): 216.x
Nevus, mucosal(junctional): 210.x

Example with Ref:

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