In order to test Medicare’s ability to properly process ICD-10-coded claims, you decide to send in occasional real patient claims with ICD-10 diagnostic coding to your MAC prior to Oct. 1, 2015. You expect that if the claims are paid, you have coded properly.
As test billing in the ICD-10 format seems to constitute a burden to your office, you decide to avoid the hassles of test billing with ICD-10 codes prior to Oct. 1, and will simply confidently “go live” with the new code set on Oct. 1.
In order to ensure that your claims are appropriately processed after Oct. 1, 2015 you submit diagnosis lines to your Medicare Administrative Contractor with both ICD-9 and ICD-10 codes for the same diseases/conditions.
A patient comes in for an examination following an excision of a Merkel cell carcinoma six months ago. You do a complete skin examination, palpate nodal basins, and evaluate any pertinent laboratory results. As no new tumor is identified, you append a diagnosis code for “Personal history of other malignant neoplasm of skin” (not melanoma): Z85.828.
You biopsy and simultaneously destroy with curetting and electrodesiccation a lesion located on the left arm that you are certain is a basal cell carcinoma. You hold billing until the receipt of the pathology report. Whoa! The lesion is actually an amelanotic melanoma! You then apply ICD-10 code C43.62, malignant melanoma, left arm, and bill the insurer.
You excise a melanoma on the right chest. Your insurance biller submits a bill with ICD-10 diagnostic code C43.59. You are surprised at the coding, as you specified the right side and expected the last digit in the code to be a “1”, denoting a melanoma located on the right side of the patient. Was the billing done correctly?
A patient with diabetes mellitus presents with a bilateral pretibial eruption that you diagnose as necrobiosis lipoidica diabeticorum (NLD). Your biller selects ICD-10 code L92.1, necrobiosis lipoidica, and sends the bill to the insurer.
During the course of a Mohs surgery requiring three stages of tissue excision, with two tissue blocks in the first stage and one tissue block in the second and third stage, you request one special histochemical stain to be done on the first and second stage of tissue excision. You bill 17311 and 17312x2 for the Mohs surgery plus 88314-59x3 for the frozen section special stains.