CODING COACH: Play the Lesion Excision Waiting Game

Subscribe or sign in to view the full article.

Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This piece explains differing guidance on lesion excision coding when pathology results are pending or later disagree with the initial clinical impression. It is aimed at coders, billing staff, and compliance professionals who need to compare Medicare contractor policies, understand diagnosis-reporting timing, and follow applicable office or payer guidance for skin lesion removal. The article also references older ICD and CPT guidance, local coverage determinations, and the reimbursement impact associated with different coding approaches.

Why This Topic Matters

Lesion excision coding can vary by payer policy and timing of diagnosis confirmation, which affects claim accuracy, compliance risk, and payment. Understanding the article helps readers evaluate how pathology, contractor rules, and office policy influence coding for skin lesion removals.

Article Sections

  1. Prevent Mislabeling by Waiting for Definitive Diagnosis

    Discusses the general issue of when to wait for pathology confirmation before finalizing lesion excision reporting. It compares broad approaches referenced in the article and frames the compliance concerns involved.

  2. Play It Safe With Unspecified Dx Under Old NGS Plan

    Summarizes an older Medicare contractor policy discussed in the article and its approach to lesion excision reporting when the diagnosis is not fully established. It also notes the geographic scope of the contractor’s jurisdiction and the rationale described in the source.

  3. Lose $57 Plus for Refusing to Mislabel

    Reviews the payment impact the article associates with different lesion excision coding approaches. It also references the contractor policy change described in the source and the reimbursement comparison discussed there.

  4. Follow Path Report Unless Your Policy Differs

    Covers another payer policy perspective described in the article and the importance of checking contractor and office guidance. It ends with a general reference to older neoplasm coding guidelines.

What You Will Learn

  • How the article frames timing of pathology confirmation in lesion excision reporting
  • How differing payer policies can affect lesion excision coding
  • Why diagnosis selection timing can influence claim payment and compliance
  • How the article positions contractor guidance and office policy in relation to lesion excision reporting

Who Should Read This

  • Medical coders
  • Billing and reimbursement staff
  • Compliance professionals
  • Physician practices
  • Dermatology and surgical coding staff

Codes Discussed

  • CPT: 11420
  • CPT: 11620
  • ICD-9-CM: 239.2

Code Ranges Discussed

  • CPT: 11400-11446
  • CPT: 11600-11646
  • ICD-9-CM: 140-239

Subscribe or sign in to view the full article.

Keep pace with evolving Medicare regulations — and onboard your team — with timely analysis of critical updates interpreted in an easy-to-follow, easy-to-apply format. Your subscription to TCI's Medicare Compliance & Reimbursement Alert will equip you to navigate code and guideline changes, CCI edits, and revisions to modifiers, payer policies, the fee schedule, OIG target areas, and more.

  • Current newsletters added each month
  • Fully searchable archives - over 4200 articles
  • ALL years/issues back to 2003 organized by year and issue
  • Codes mentioned in articles are linked to Code Information pages
  • Code Information pages link back to related articles

This feature is currently unavailable for online purchase. For more information, please call 801-770-4203 or Contact Us.

Thank you for choosing Find-A-Code, please Sign In to remove ads.

Aimee- AI -powered coding assistant - Try it now for Free Would you like Aimee - AI
to help you with this?