ED Coding & Reimbursement Alert - 2009 Issue 9
Confused by Recent Lesion Coding Directives From NGS? Here's the Scoop
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Article Overview
This article examines a disputed local coverage determination from National Government Services affecting lesion excision coding and the response from coding professionals and NGS representatives. It explains the broader issue in terms of diagnosis selection timing, pathology-related coding workflow, and how the discussion intersects with CPT lesion removal categories and older ICD-9-CM guidance. The piece is aimed at coders and billing staff who handle lesion excision claims and need to understand the scope of the guidance change and the follow-up clarification.
Why This Topic Matters
The article matters because it addresses a payer guidance issue that could affect how lesion excision claims are coded and supported, especially when pathology results are involved. It also signals possible revision or rescission of the disputed guidance, which can affect compliance and claim consistency.
Article Sections
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Decipher the NGS LCD
Explains the source of the controversy and the general coding issues raised by the Medicare contractor guidance. It also places the dispute in the context of prior diagnosis coding guidance and lesion excision reporting.
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NGS Officials Promise a Correction
Summarizes the contractor’s stated plan to clarify or remove the disputed language. It notes the status of the guidance and the communication around the revision.
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Stick With Previous Coding Guidelines
Discusses the broader coding approach referenced by the article and the lesion excision code groupings involved. It also addresses a scenario involving pathology findings and follow-up reporting.
What You Will Learn
- The general nature of the NGS lesion excision coding dispute
- How the article frames the relationship between pathology and lesion excision coding
- Which broad CPT lesion removal code groupings are discussed
- How the article situates the issue within older ICD-9-CM guidance
- What kind of clarification NGS said it would issue
Who Should Read This
- Medical coders
- Coding auditors
- Billing staff
- Physician practice managers
- Compliance staff
- Specialty surgery practices
Codes Discussed
Code Ranges Discussed
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