tci Medicare Compliance & Reimbursement - 2009 Issue 19
CODING COACH: Play the Lesion Excision Waiting Game
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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
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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.
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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.
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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.
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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
Code Ranges Discussed
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