Wiki denial for invalid dx with CPT billed

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lindseyb

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Hi!

I am working a denial from Medicare that I need some help with. The procedure code 11402 was performed in the office with diagnosis code 782.2.
The patient had an abdominal wall mass.
Medicare is denying the dx code stating that it is not valid for this procedure.
I have searched all over and no dx code I have found will pass my "code correct" for the Medicare LCD's.
Can someone point me to a LCD of allowed dx codes for this CPT or is there a dx code I am missing?
Or is there a different a CPT code that I should be using instead.

Thank you in advance for the help!
Lindsey B.
 
lindseyb said:
Hi!

I am working a denial from Medicare that I need some help with. The procedure code 11402 was performed in the office with diagnosis code 782.2.
The patient had an abdominal wall mass.
Medicare is denying the dx code stating that it is not valid for this procedure.
I have searched all over and no dx code I have found will pass my "code correct" for the Medicare LCD's.
Can someone point me to a LCD of allowed dx codes for this CPT or is there a dx code I am missing?
Or is there a different a CPT code that I should be using instead.

Thank you in advance for the help!
Lindsey B.
Click to expand...

Without seeing the op note there is a more specific abdominal wall mass code you could try. Look at 789.30 with the fifth digit specifying the quadrant.

I hope this helps. Good luck :)
 
dclark7 said:
In order for anyone to help with the correct code you would need to post the redacted note.
Click to expand...

I agree. The codes you used do not go together. You cannot use a benign excision code without a path report and you would not use an integumentary excision code for an abdominal mass. To be able to assist the note needs to be posted
 
Coding Companion

I would also suggest obtaining the Coding Companion Book from Optum for the
specialty of your office. The book actually suggests possible diagnosis codes
with each cpt code. Utimately, though, as a coder, you need to obtain the notes in order to pick the correct code. Documentation always needs to substantiate both the cpt and the ICD-9 / ICD-10 Code.
 
I am not sure of the answer, but have a question regarding your question- If the documentation led to the original dx code that was denied, can you really just change the dx code to a more appropriate code to get it paid or does the doctor have to make changes to his/her notes? In your appeal do you just state an incorrect code was chosen?

Thanks for any feedback
 
the error was that the original CPT code was incorrect. She was using a skin excision code. The claim was not paid so the process is to resubmit with the corrected CPT code.
 
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