March 4, 2021

Question:
My physician excised a lesion the was 1.5cm on the trunk. He documented it as a benign lesion but sent it to pathology for confirmation.  We submitted CPT code 11402 for the benign lesion of the trunk. The lesion came back malignant.  Shouldn’t we wait for the pathology report prior to submitting the claim? How does this affect the RVU’s?

Answer:
Yes, you should wait for the pathology report for confirmation when the dermatologist sends the specimen to pathology. You would have coded the encounter as 11602 for the malignant lesion excision. The work RVU for 11402 in 2021 is 1.45 with the total RVU (work, practice expense and malpractice) as 5.13.. For the malignant lesion excision (11602) the work RVU is 2.27 and the total RVU is 7.31. which is certainly a loss of revenue to the practice. We recommend if the physician is sending the specimen to pathology you wait for the path report before coding the claim. You might want to go back and amend your claim.

*This response is based on the best information available as of 3/4/21.