Coding excision malig lesions

donnar

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Hi, we have encountered denials from medicare related to pc 11620-11646, exc of malig lesions stating dx is inconsistent with procedure, even when we have used malignant dx codes. This is happening in both ASC and the office setting. Any insight to what is happening, and what other codes selections might be better to use. Thank you for your help.
 

Treetoad

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Are the denials "carrier specific"? First I would contact the carrier--it may just be an error in the their system.
 

jackjones62

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Hello, I agree with Treetoad, check your local carrier....I am in CT and we now have a new carrier and nothing but problems......a new policy concerning "benign" lesion removal was implemented in 7/2008 but it seems to affect the "malignant" lesions as well, though it should not, we are getting denials and having to resub.

Jennifer
ENT
 

donnar

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Thanks for your input, nice to know we are not alone down here in FL. We will try to get in touch w/our medicare rep.
 

Hopp

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Coding Malig. lesions

If it is Medicare than you might want to check your LCD Policy(Local Coverage Determination-its on the Medicare Website) - It will tell
you exactly what diagnosis codes themselves will pay and what diagnosis codes need secondary diagnosis codes.
Hope this information is helpful
Deborah Hopp, CPC
 
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