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Covered diagnosis for aerobic bacterial culture

C

CatchTheWind

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Boca Raton, FL
Quest is telling us that Humana is denying an aerobic bacterial culture for diagnosis L.089 (skin infection NOS). Is there a better code to use? The patient is complaining of erythema at the site of a surgical wound - should we use erythema, or surgical wound complication, or ???
 
I've had some experience with payers denying testing due to a diagnosis code. Some payers have clinical policy guidelines they follow and will pay for a CPT code only if the ICD 10 supports medical necessity. Humana may have information on Availity that may point you in the right direction.

I hope this helps. :)
 
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