subject: Rid 'uncertain behavior' confusion with sure-success tips on 238.2 use [print this page] If you always use diagnosis code 238.2 when reporting 11100 for a biopsy procedure your dermatologist carries out, you are setting your practice up for disaster. The key to knowing when to use the 'uncertain behavior diagnosis code is understanding what that code descriptor really means. Follow these expert tips to reduce denials and to see to it that you are choosing the right diagnosis code for all your 11100 claims.
Wait for pathology prior to selecting a code
When your dermatologist carries out as biopsy, you should always wait until the pathology report comes back to select the proper diagnosis and procedure codes to report even though this'll not always have an impact on the CPT code you will choose.
Know the meaning behind 'uncertain' codes
When you report 238.2 as the diagnosis for a biopsy procedure, you are telling the payer what the pathologist said in his path report that he was uncertain as to the morphology of the lesion. Uncertain behavior doesn't mean that the coder is not certain or that the doctor thinks the lesion looks suspicious although it might be benign.
Uncertain behavior means that a specimen has been examined by a pathologist and that the cells are of mixed types.
Do not rush coding just to get paid
You shouldn't code just to make sure you will be paid for a procedure. In the case of a biopsy, waiting to code until you have the pathology report shouln't affect your reimbursement anyway. You may have to wait a bit longer to get the reimbursement if you need to hold a claim while you wait for the pathology report; however your coding will be more spot on. If you biopsy a lesion and the results come back as precancerous, this is exactly the diagnosis you would use so that it is a perfectly payable diagnosis. On the other hand, insurers are looking for more reasons to deny payment. If you had carried out a biopsy and indicated that the patient has hyperplasia and then the physician found out that the biopsy indicated melanoma and the patient returned to have excision of the melanoma and the insurer ever compared the documentation there could be problems.
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Rid 'uncertain behavior' confusion with sure-success tips on 238.2 use
By: James Smith
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