Wiki Coding

[fcctn-2008@yahoo.com]

Hello,

How do I code this case , a Medicare patient has a painful right ankle pressure ulcer , when billed to Medicare denied for not necessity , help please ,
"These are non-covered services because this is not deemed a 'medical necessity' by the payer

Cpt 11423 and 12042
DX L98499

 

[ntreber]

my 1st guess would be an issue with the diagnosis code.
L98.499 = Non-pressure chronic ulcer of skin of other sites with unspecified severity
In your statement above you state that it is a Pressure Ulcer and L98.499 is for a NON - Pressure ulcer.

 

[vinessachilders]

I know for our practice, Medicare does not generally cover any visits whose primary diagnosis is related to hair, skin, nails, or teeth. I think it has to do with Medicare preferring those to be treated by specialties, not general practice.