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Diagnosis Coding Help
Can you please assist with the diagnosis for a Compound Dysplastic Nevi of back?
Question:
Can you please assist with the diagnosis for a Compound Dysplastic Nevi of back?
Biopsy confirmed and not completely excused. Patient comes in for excision of lesion. What diagnosis code should I use?
Answer:
The correct diagnosis code for a dysplastic nevi of the trunk is D22.5 (melanocytic nevi of trunk)
*This response is based on the best information available as of 07/28/22.
Mohs Coding Dilemma
I am new in Dermatology coding and am currently coding for a Mohs surgeon. I was instructed that if the patient comes in and does not have a confirmed malignancy based on a pathology report and the physician does a biopsy to confirm the malignancy prior to Mohs surgery we can bill 88311 for pathology and the Mohs procedure on the same date. Is this correct?
Question:
I am new in Dermatology coding and am currently coding for a Mohs surgeon. I was instructed that if the patient comes in and does not have a confirmed malignancy based on a pathology report and the physician does a biopsy to confirm the malignancy prior to Mohs surgery we can bill 88311 for pathology and the Mohs procedure on the same date. Is this correct?
Answer:
If there is not a pathology report that confirms the patient has a malignancy and meets the criteria for Mohs surgery then you can report Mohs (17311-17315) based on the anatomic area, and stage performed and 88311-59. You must use a 59 modifier because the Mohs procedure codes and 88311 are bundled under the National Correct Coding Initiative. CMS states, “The surgical pathology codes 88300-88309 and 88331-88332 and 88342 are part of the Mohs surgery and are bundled into 17311-17315. One exception is that it would be appropriate to report 88311 with Modifier 59 if a pathology report does not exist for the patient or the pathology report is 60 days or older or cannot obtained (CMS). Keep in mind Code 88311 (Surgical Pathology, gross and microscopic examination) for the preparation and interpretation of the slides taken during the procedure is included in the Mohs procedure codes. Do not forget to also report the appropriate biopsy code with Modifier 59.
Two CMS reference might be helpful for you to review below.
CMS Mohs reference:https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1318.pdf.
*This response is based on the best information available as of 06/30/22.
CPT code 10080 versus 10081
I am trying to code an I&D of a pilonidal cyst. CPT 10080 is simple and 10081 is complicated. How to do I know which code to choose?
Question:
I am trying to code an I&D of a pilonidal cyst. CPT 10080 is simple and 10081 is complicated. How to do I know which code to choose?
Answer:
Great question, you would report CPT 10081 (complicated) if the procedure requires marsupialization, approximation of the wound’s edges, and/or primary closure.
*This response is based on the best information available as of 06/02/22.
Acute Versus Chronic Conditions for Office E/M Services
When determining if an illness is chronic versus acute is it based on how long the patient has had the condition or is it based on if the condition is considered a chronic or acute condition?
Question:
When determining if an illness is chronic versus acute is it based on how long the patient has had the condition or is it based on if the condition is considered a chronic or acute condition?
Answer:
The AMA defines chronic as: A problem with an expected duration of at least a year or until the death of the patient.
An Acute problem is “A recent or new short-term problem with low risk of morbidity for which treatment is considered. There is little to no risk of mortality with treatment, and full recovery without functional impairment is expected..” An acute problem can be uncomplicated, acute complicated or acute with systemic symptoms. Please reference this link for the AMA definitions.https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf.
Keep in mind the practitioner should document the whether the condition is acute or chronic if the condition is stable or exacerbating.
*This response is based on the best information available as of 05/05/22.
New Patient Visit Denied, What Should I Do?
One of our dermatologists saw a patient the first time in our office. We billed 99204. The insurance carried denied the service. I contacted the insurance carrier and was told that the patient was an established patient to the practice and should be reported as an established patient. The patient did see another dermatologist in our group practice who did an intralesional injection a year ago, but it was in another city. Is the insurance carrier correct or should I appeal this?
Question:
One of our dermatologists saw a patient the first time in our office. We billed 99204. The insurance carried denied the service. I contacted the insurance carrier and was told that the patient was an established patient to the practice and should be reported as an established patient. The patient did see another dermatologist in our group practice who did an intralesional injection a year ago, but it was in another city. Is the insurance carrier correct or should I appeal this?
Answer:
Since the dermatologist in the other city is part of your group and is of the same specialty with the same taxonomy code, the patient encounter for the physician in your office should be coded as an established patient visit not a new patient visit.
Per CPT Coding Guidelines: “A new patient is one who has not received any professional services from the physician/qualified health care professional or another physician/qualified health care professional of theexactsame specialty andsubspecialtywho belongs to the same group practice, within the past three years.”
Since your claims was denied, it is recommended that you file a corrected claim and bill the encounter as an established patient.
*This response is based on the best information available as of 04/7/22.
Counting Problems Addressed for Medical Decision Making
If a patient has one stable chronic illness and one acute uncomplicated illness without systemic symptoms, can we “up” the level of Problems Addressed to Moderate?
Question:
If a patient has one stable chronic illness and one acute uncomplicated illness without systemic symptoms, can we “up” the level of Problems Addressed to Moderate?
Answer:
No, sorry, unfortunately it does not work that way. The problems are no additive or cumulative. One stable chronic illness and one acute uncomplicated illness without systemic symptoms is still Low Problems Addressed.
*This response is based on the best information available as of 03/24/22.