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nelstx2

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Coded as 99214 -25 and 11404, being denied Should I have coded as 11000?
PROCEDURE IN FULL;
LOCATION:lower back;inferior aspect of surgical incision at approx L4-5
SIZE:Incision OS 2mm;tract 1.2cm;
REASON FOR SURGERY:Recurrent cellulitis/drainage of surgical wound;r/o FB/suture tract
After betadine prep the ltissue was infiltrated w/ xylocain 2% w/ epi. Following adequate local analgesia the 2mm pore was excised in an elipitical fashion and the central core followed down to the fascia where it terminated at 1.2cm in depth;the area ws debrided until smooth then irrigated w/ NS x 60 cc;The wound was then loosely closed w/ a mattress using 4.0 and two sperficial interrupted sutures;this is not drawn tight to allow drainage
SUTURE: Prolene 4.0
SPECIMEN SENT TO PATH: yes
A/P # incision infection POSTOPERATIVE INFECTION (998.59.):
# SUPERFICIAL FOREIGN BODY (SPLINTER) OF TRUNK WITHOUT MAJOR OPEN
WOUND INFECTED (911.7):
 
11404 vs. 11000

Hi nelstx2,

What was the denial reason you got? Curious to know but I don't think that the 11404 would not be appropriate for the diagnosis. This category is for excision of benign lesions, the note is in regard to an infection.
 
Wrong Forum

Hello,

You may get more responses if you post under a specialty or in the general discussions. This forum is primarily for job related posts.

Good Luck

Thanks,
Julie
 
This is a basic postop I/D = 10180.

I can't comment on the E&M as only the Op Report information was shared. There is no documentation to support a FB removal (we don't code R/O rule outs) when a removal was not performed, 998.59 only.
 
This is an I&D, not a benign lesion removal. Also, billing an E&M with a minor surgery is tricky these days. Check the CCI Edits. Even appending the -25 with a minor procedure won't guarantee payment. What/when was the original procedure? Are you bumping up against global days? What was the denial reason?
 
DOS is 11/14/13, was denied for Medical necessity (medicare patient) looked in the LCD-24361- this was a removal of a suture 11 months after a surgery....

History of Present Illness: Nurse med Check :UTD, pt has extreme pain in his left leg radiating from his back
LOWER BACK INCISION:recurrent drainage--suspect retained sutures w/ tract;The pt had surgery on 1/17/13 for a decompressin laminectomy by Dr XXX ;Since then he has had severarl episodes of drainage from the lower aspect of the incision that repsonded to antibitoics for a short time then recurred;This last month it did not resolve and it was decided to remove area of drainage;
 
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