17000 destruction of precancerous lesion, or benign lesions

amylynn911

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We have been encountering the CPT 17000 with DX of L57.0 being denied for cosmetic purposes, and having to send in documentation to Medicare and private payers. Has anyone else had this happen, was wondering if there is something going on with either the CPT and or diagnosis? We have contacted the ADD and they have no knowledge of anything going on. Any help would be great! Thank you
 

Chelle-Lynn

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We have seen this with some of our carriers. They are considering the diagnosis code to be possibly cosmetic. The purpose of the medical records is to determine if the growths are problematic, possible hx of cancer, bleeding, etc. If it is determined that the growths are being removed just because they are unsightly then the service will be denied.

This is based on the general definition of L57.0 which is noted as:

This condition causes small, rough growths on the skin that occur due to sun exposure. While not considered particularly dangerous, these growths can develop into skin cancer, though this is rare
 
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