Neurology & Pain Management Coding Alert

Question: Our neurologist sometimes completes a punch biopsy to look for small fiber neuropathy. The payer denied our claim with diagnosis V80.09. What should I change when we resubmit? Arkansas Subscriber Answer: Typically, neurologists perform skin punch biopsies as a diagnostic study to determine whether the patient has a small fiber neuropathy (or to rule out that possibility) rather than as a screening test. The patient usually has signs/symptoms that make the diagnostic study medically necessary. Small fiber neuropathy is often considered to be one of the major causes of painful burning sensations in the feet, especially in the elderly. According to ICD-9 Guidelines, "Screening is the testing for disease or disease precursors in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease...The testing of a person to rule out or confirm a suspected diagnosis because the patient has [...]