Wiki 11420 Medicare denial for frequency

[alp.jeffrey]

I'm actually a urology coder but I need some help from those of you who may do lesion removals more frequently. I surely don't do them. Medicare is denying a claim for frequency. Here's what we billed (not me...a coworker):
11422 x2
11421 x2
11420 x2
dx: L72.3
Here's the note:
Findings: Multiple sebaceous cyst on the order of 5mm to 2cm involving the groins, scrotum and perineum at the junction of the scrotum and perineum.
Procedure: 2 - 15mm cysts were excised with a 12 blade using sharp and blunt dissection from the groin crease. These were closed after irrigating the wound. A 2cm left upper lateral scrotum cyst was excised in similar fashion. This was closed in 2 layers. Similar excisions and closures were performed of the right mid scrotum, left mid to lower scrotum and one at the posterior scrotum near the perineum. A total of 9 cysts were excised.

What say you? Do you agree with the way it's billed? Should we be putting the codes one line at a time with 1 unit or is billing 2 units per code generally acceptable? Thanks to anyone who can help.

 

[iowagirl77]

The note starts out fairly specific on size and quantity, but devolves from there.
2 x 1.5 cm
1 x 2 cm
3 additional areas were noted, but no size was mentioned. It is unclear how the provider came up with 9 total, so I can see why only 6 total were billed. Since they didn't state size on the last 3 areas I'd code the smallest size for those. It is possible the coder was able to get information from the pathology report and so they coded differently based on that. But with the info you provided I'd code it as:

11422 x3
11420 x3

If they deny for frequency, I'd appeal with records. I wouldn't separate out each unit on separate lines.