Gator
Networker
MEDICA advantage denied removal of sebaceous cyst, L72.3, for lack of additional diagnosis. (bleeding, itchy, inflamed etc.) The LCD article states that L72.3 is one of the codes that will by itself allow payment. Therefore, we did not get an ABN. Additionally, removal of benign skin lesions that do not pose a threat to health or function is considered cosmetic (Cosmesis) and is statutorily non-covered. The cyst was in a sensitive area and patient wanted it removed before it became infected. I have sent copy of the LCD showing we do NOT need an additional Dx. They continue to deny stating we need to send in a corrected claim and LCD denials are NOT appealable. They will not budge. I was under the impression that Advantage plans follow our local LCD guidelines. We or MEDICA are clearly missing something in the interpretation of this LCD.
Thoughts?
Thoughts?