Lesion Removal: Tips To Ensure Correct Diagnosis And Maximize Pay

Waiting for the pathologist to measure an excised lesion could cost you dear

. However not waiting for the pathology report could burden the patient with a misdiagnosis. Here are some tips to ensure correct diagnosis and maximize pay.

Measure first

You should choose the proper lesion excision size code based on the surgeon's report. If the surgeon does not measure the lesion before he cuts it out, he is cutting his reimbursement in half.

Once the specimen is in the jar, the specimen shrinks down to half its original size. If the surgeon does not put the original size in the note, the coder has to code based on the smaller excision size listed in the pathology report. And this will cost the practice a lot of money.

CPT's excision sizes, including margins, are based on the surgeon's measurements. You should train providers to measure an excision and document it with a statements such as I'm going to excise this X cm length by X width lesion. I took 4 cm margins." You should also explain to your surgeon the financial impact of including these details.

Hold diagnosis for Path Report

Always make it a point to select the malignant or benign excision code on the basis of the results of the pathology report, even if the surgeon does not have that information during the time of the surgery. The pathology report offers the definitive diagnosis that serves as the basis for the CPT excision code selection.

A surgeon might visually identify a lesion as benign or malignant, however, you still want to code the excision based on the pathology report. In the event a benign-appearing lesion really ends up being malignant, the physician has to protect himself for malpractice reasons. On the other hand, you don't want to mislabel the patient. The diagnosis could cause the patient's insurer to drop coverage.

Check Anatomic Location

After getting the pathology report, review the documentation for excision size and location. Then it is all about location from the anatomical site to ensure the practice is getting all revenue.

Each anatomical group contains lesion excision sizes ranging from small to large lesions.

For further details on this, sign up for a medical coding guide like Supercoder.

by: James Article

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