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Wiki Diagnosis for lesion not sent to pathology

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Mklaubauf

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Hi,
We have Medicare patients that come in for a lesions that we do cryotherapy on as a first step and then if it reoccurs, then they will excise it. I always use the benign cryotherapy code of 17110 . It is the DX I have problem with. Dx. of 709.8 is not covered by Medicare.

Could I use 216.3 for example if took a lesion off the nose?

Thank you,
Marci
 
You cannot use the 216.3 without a path report. 709.8 is all that is available and all the documentation will support. It does not matter that Medicare will not pay for it. You need an ABN from the patient.
 
I would review Medicare LCD# L24361. Go to http://www.cms.gov/mcd/results.asp?show=all&clickon=search and search for this #. This LCD goes over all the covered dx codes for removal of benign lesions. I would also suggest that your dr document whether it is a 'lesion', a 'neoplasm', an 'sk' or an 'ak'--if it is an 'unspecified nature' neoplasm, then you can use dx 238.2, inflamed sk's are 702.11, ak's are 702.0 (which are all covered by Medicare). Otherwise, I would speak with your dr and let him/her know the situation-if the documentation as it stands doesn't support more specific dx codes, then he/she wil not be getting paid, maybe dr will choose to to pathology and/or provide more specific documentation.

Hope that helps!

M.E., CPC
 
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