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Wiki 11402 and 12032 for superficial mycoses

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Renaep

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Hi,

Needing some guidance.. We billed 11402 and 12032 with ICD 10 code B36.8 to BCBS. They covered the repair but not the excision because B36.8 is not a covered code for 11402. However, it is covered for 12032. Any advice on which ICD-10 codes for superficial mycoses are covered for both 11402 and 12032? B36.9 maybe?

Thanks!
 
We haven't had experience with this specific diagnosis, however we have had lots of denials for excisions from BCBS. We found that the particular plan (BCBS Mass) had a policy for Benign Skin Lesions that indicates a required secondary diagnosis is necessary to prove medically necessity. I've included the specific policy for BCBS MASS, I wonder if whatever plan you are working with has a policy like this. We ended up having to write off our claims because the providers didn't document any additional symptoms or diagnoses to code to. We have to update our process for this particular plan. Hope this helps!
 

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