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Wiki Denials on benign excision's first scrub through software

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LadyT

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Local Chapter Officer
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Broadway, VA
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Just recently I am getting rejected claims before I can get them out to insurance, rejected reason states " PER LCD or NCD guidelines procedure codes 11404,11421,11301,11402 has not mett the associated diagnosis code relationship criteria for CMS".
This is just started. My doctor is very careful about what should be removed per guidelines. These were all either painful, bleeding of inflamed and documented however I can not get the claims pass this edit and on to insurance. Any suggestions?
 
Something could have been revised in the policy so I think you should check your local Medicare LCD's to find out for sure.
 
LadyT said:
Just recently I am getting rejected claims before I can get them out to insurance, rejected reason states " PER LCD or NCD guidelines procedure codes 11404,11421,11301,11402 has not mett the associated diagnosis code relationship criteria for CMS".
This is just started. My doctor is very careful about what should be removed per guidelines. These were all either painful, bleeding of inflamed and documented however I can not get the claims pass this edit and on to insurance. Any suggestions?
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do you have pathology reports for the excisions? what diagnosis codes are you using?
 
it's likely the diagnosis. Recently in PA they started to not pay for D22... dx on benign excisions where as in years past they did. We went back and forth on this and came down to the lab we were using was coding all nevus as D22 however many of them were suspicious or extended to margins and needed excision etc and came to find after many months they needed to tighten up the coding at pathology
 
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