Denials for Debridement of Diabetic Ulcers

[MnTwins29]

Our Wound Care Center will often treat diabetic ulcers with debridement. The NGS LCD lists the ulcer ICD-9 codes (707.xx) as acceptable diagnoses. However, we have been getting denials for diabetic ulcers because per coding guidelines, the diabetes code has been listed first and therefore the services are deemed medically unnecessary, even though the ICD-9 coding guidelines specifically state to code diabetes first then the manifestation. For anyone else whose MAC is NGS, what do you do to solve this issue? TYIA.

 

[mitchellde]

As long as you are using the diabetes code with the fourth digit of 8 and listing it first and linking both dx codes to the procedure then there is no problem with the claim, you need to appeal the claim to have the payer fix the edit.

 

[MnTwins29]

As long as you are using the diabetes code with the fourth digit of 8 and listing it first and linking both dx codes to the procedure then there is no problem with the claim, you need to appeal the claim to have the payer fix the edit.

Even if the LCD doesn't list the diabetes codes as acceptable? I will contact NGS, though, in the meantime. Thank you.