kathymoon
Guest
I am in Michigan. Our MAC is WPS. I am getting rejections from Medicare for 97597 and 97598 as not medically necessary. The diagnosis is L97821 and L97871, non-pressure ulcers of the legs. I assume it is rejecting due to the diagnosis. Medicare requested records and have reviewed and rejected. I need to appeal but I'm not sure what I'm fighting. The LCD (34587) list the acceptable diagnoses as all pressure ulcers and no other diagnoses.
So a couple of questions. Note: Medicare has already reviewed the documentation.
What can I appeal? The documentation states "selective" debridement. So the only other option would be an E&M code??
The documentation states: Lower extremity wound, or venous insufficiency with venous ulcer. None of which ICD-10 codes are listed in the LCD.
Not sure where to go from here. Would really appreciate some feedback.
THX
So a couple of questions. Note: Medicare has already reviewed the documentation.
What can I appeal? The documentation states "selective" debridement. So the only other option would be an E&M code??
The documentation states: Lower extremity wound, or venous insufficiency with venous ulcer. None of which ICD-10 codes are listed in the LCD.
Not sure where to go from here. Would really appreciate some feedback.
THX