Wiki 21012-excision of soft tumor in office>2 cm

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mercyolson

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This CPT code 21012, code has been used twice in our office, but only paid once. The denial rad,"cannot be performed in an office setting". Has anyone had success with payment in the office setting?
Any information will be greatly appreciated.
Mercy
 
According to CMS, 21012 has a global of 90 days and is payable in facility only; I have come across this issue before with a "superficial" lymph node biopsy done in the office on 2 Medicare patients that were denied for the same reason, appeals failed; of your 2 procedures, the one procedure that got paid, was it a commercial carrier? and the one that denied, was is Medicare? or State? Of course you can appeal....

Jennifer
CTENT
 
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