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E/M coding - Multiple Nevi

L

Lynne77

Contributor
Messages
18
Location
Duluth, GA
Hello!

If a patient has multiple nevi, does each one count as a separate problem as far as E/M coding? We have a patient who was seen and had a biopsy done on one of the nevi as it was irregular shaped. The payer is denying the E/M for the other nevi which were documented to be regular shaped but the provider marked for observation.

Thanks!
 
I would appeal with your documentation. If the provider clearly documents the lesion of concern separate from the remaining nevi your E/M and biopsy code should be supported. I would also double check your Dx codes and make sure you are reporting the site specific, not D22.9 to indicate the separate sites. If your software uses IMO terms it may be leading your provider to the wrong diagnosis code.
 
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