Wiki Abscess

[NESmith]

Our doctor saw a patient at the hospital for a gigantic abscess of the left shoulder and posterior lateral chest 30 cm x 30 cm x10 cm. He did an Incision and Drainage of the gigantic complex left shoulder and chest wall abscess. He also did a wide excisional debridement of necrotic tissue left posterolateral chest wall with scalpel and scissor to the level of the thoracic chest wall fascia. We billed a 23030, 21501 & 11043. Insurance is denying as bundled. Was this billed correctly? Thank You for your help.

 

[dcolin]

abscess

What dx. codes did you use? Did they deny the whole claim? I know that it is difficult to get debridement's paid for medicare patient's.

 

[NESmith]

The dxs used were 682.3 & 682.2. The only cpt code that denied was 11043. But CCI edits states there is no bundling. Am I missing something?

 

[thegranddiva1]

Try adding a 51 modifier and appeal with medical records, depending on the insurance you might (small chance) get paid, debridements when performed with other procedures are typically denied by the insurance company.

Good luck,

Roni Jones, CPC

 

[cmartin]

Also 11043 includes muscle, and above says to the level of the fascia.