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atypical nevus

Tauna Posted Wed 16th of January, 2013 21:35:25 PM

Pathology report on a mole from a patient's thigh says "junctional nevus with mild atypia extending to peripheral margin." The pathologist also commented to consider a "conservative reexcision" and my provider followed that recommendation. I'm unsure what ICD9 code to use for the reexcision on this Medicare patient. Thanks for your help.

SuperCoder Answered Tue 22nd of January, 2013 23:42:31 PM

I think 216.7 is the one!

A dysplastic nevus (also known as a: Atypical mole, Atypical nevus, B-K mole, Clark's nevus, Dysplastic melanocytic nevus, Nevus with architectural disorder[1]) is an atypical melanocytic nevus;[2] a mole whose appearance is different from that of common moles. Dysplastic nevi are generally larger than ordinary moles and have irregular and indistinct borders. Their color frequently is not uniform and ranges from pink to dark brown; they usually are flat, but parts may be raised above the skin surface. Dysplastic nevi can be found anywhere, but are most common on the trunk in men, and on the calves in women.

Keratoacanthoma (ICD 9 CM code is 238.2) is a relatively common low-grade malignancy that originates in the pilosebaceous glands and closely resembles squamous cell carcinoma (SCC). In fact, strong arguments support classifying KA as a variant of invasive SCC. The pathologist often labels KA as "well- differentiated squamous cell carcinoma, keratoacanthoma variant". KA is characterized by rapid growth over a few weeks to months, followed by spontaneous resolution over 4–6 months in most cases. KA reportedly progresses, although rarely, to invasive or metastatic carcinoma; therefore, aggressive surgical treatment often is advocated. Whether these cases were SCC or KA, the reports highlight the difficulty of distinctly classifying individual cases.

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