I always use 938.2 "neoplasm of uncertain behavior..." for the biopsy, and I don't think there is any problem with insurance companies accepting it.
If the biopsy turns out to be malignant, I usually send the patient to a surgeon for re-excision if necessary, and they get the big bucks.
If I do the re-excision myself, we charge a second fee.
It would be rare -- at least in my practice -- to do a large excision without a prior biopsy, and with the expectation that the lesion would be malignant, but if we do, we have to wait until the pathology report confirms it before billing.
Yes, a very crazy system.
But not likely to change any time soon given inertia and entrenched interests.
More likely a complete collapse is in store for us.
