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uncertain behavior neoplasm

Super Posted Thu 21st of July, 2011 12:32:03 PM

I have a surgeon who wants to use uncertain behavior neoplasm, breast instead of lump in breast prior to testing.

When is it appropriate to use uncertain behavior instead of lump?

SuperCoder Answered Thu 21st of July, 2011 17:04:10 PM

"Neoplasms of Uncertain Behavior" are those for which the final behavior cannot be determined at the time of the biopsy or other excisional procedure because the cells may be undergoing malignant transformation but a firm distinction between malignant and benign can't be made. In most cases, follow-up care is provided to help ascertain whether the patient has any malignancy. In some instances, a portion of the specimen will be sent out to another pathology lab for another opinion. Only then is it appropriate to assign an "uncertain behavior" neoplasm code; they should not be assigned merely to get a claim paid more quickly when the initial pathology report has not yet been received. After the final pathology report has been returned from the outside pathology lab, its results should be reviewed and the coding revised.

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