Wiki Denied Destruction

[fmoore66]

Help!!!
My provider coded 17110 (Destruction) & used Dx Code B07.9 Viral Wart, Unspecified. Provider used Liquid N2 Cryotherapy. The claim is being denied, stating does not meet Dx. criteria per CMS L34938.

In review of the provider notes it states Lt groin area 7mm in diameter.

Should he use code B07.8 Other viral wart? He did not include 17340 (Liquid therapy N2 on his super bill. Should this be included as well?

Any help would be greatly appreciated
Thank you

 

[simqueen]

I looked at the LCD and I would take the documentation in the record for this encounter and compare it to the requirements in the LCD. Removal of warts is covered but there has to be documentation that it is more than a "cosmetic" procedure. If the documentation supports medical necessity, check to see if there are other codes that would supply more details/specificity and could be added to the claim. If not, then an appeal will be the only course of action if the removal was medically necessary but the codes won't clarify the situation. Otherwise, it's cosmetic and patient responsibility according to L34938.

 

[fmoore66]

I looked at the LCD and I would take the documentation in the record for this encounter and compare it to the requirements in the LCD. Removal of warts is covered but there has to be documentation that it is more than a "cosmetic" procedure. If the documentation supports medical necessity, check to see if there are other codes that would supply more details/specificity and could be added to the claim. If not, then an appeal will be the only course of action if the removal was medically necessary but the codes won't clarify the situation. Otherwise, it's cosmetic and patient responsibility according to L34938

Simqueen, Thank you very much!

 

[OpenClaims]

Help!!!
My provider coded 17110 (Destruction) & used Dx Code B07.9 Viral Wart, Unspecified. Provider used Liquid N2 Cryotherapy. The claim is being denied, stating does not meet Dx. criteria per CMS L34938.

In review of the provider notes it states Lt groin area 7mm in diameter.

Should he use code B07.8 Other viral wart? He did not include 17340 (Liquid therapy N2 on his super bill. Should this be included as well?

Any help would be greatly appreciated
Thank you

I would be careful in leading the provider on changing diagnoses, as that is not ethical, although I understand what you're saying here. If the removal of the viral wart was purely for cosmetic reasons, then the procedure will not be covered. However, if there were systemic symptoms from the viral wart, then the procedure may be able to have coverage if the other diagnosis meets LCD criteria for medical necessity.

 

[fmoore66]

I would be careful in leading the provider on changing diagnoses, as that is not ethical, although I understand what you're saying here. If the removal of the viral wart was purely for cosmetic reasons, then the procedure will not be covered. However, if there were systemic symptoms from the viral wart, then the procedure may be able to have coverage if the other diagnosis meets LCD criteria for medical necessity.

Thank you for your response. This was very helpful.