Wiki 21930 vs 11406

[O_KRECHKIVSKA]

I had the situation when we billed insurance for Excision to rule out lipoma on the Left Medial Back. We used CPT 11406 and 12032 for layer closure.
Insurance denied and when I appealed on Level 1 they denied again. The reason was: CPT 12032 is incidental to code 21931. Separate charges for code 12032 are not elibile for payment".
I did not charge 21931 but 11406. My question is - which code is the correct one in this case?

 

[mitchellde]

Was this a skin problem or a soft tissue issue and what dx code did you use.

 

[O_KRECHKIVSKA]

Hi, and thank you for responding.

DX: 214.1
skin issue.
Lipoma is a subcutaneous tissue. I am not sure if it can be incidental to code 21931.

 

[ABonnell CPC]

Did the path report indicate a lipoma and did the operative report indicate that the excision was carried down through the subcu? It sounds like it from the denial. Lipomas are most often coded with the appropriate soft tissue excision code. Sounds like you will need to submit a corrected claim.

 

[O_KRECHKIVSKA]

Hi,
what kind of a corrected claim i should make?
Yes, path indicated Lipoma, the operative notes indicated the excision was carried down through the subcu.

 

[ABonnell CPC]

Soft tissue excision codes are based on anatomical location, size, and depth of excision. Make sure the CPT you mentioned, 21931 is the corresponding CPT. It would also be a good idea for you to call the insurance to see how they prefer the corrected claim be submitted, electronic, snail mailed, or faxed. Document the call and follow up to make sure the corrected claim was received. Even though you may submit it properly, they'll often deny as a duplicate, so you will need to call to indicate that it was in fact a corrected claim, and they'll need to resubmit the claim on their end.

 

[Texascoder64]

simple or intermediate closure is included in the soft tissue excisions.

 

[ABonnell CPC]

An intermediate closure is included in the soft tissue excision codes.