Wiki Help with Sebaceous Cyst

[alyssa.hackett@auihealth.com]

Can someone please help me with this. I am not sure if this is the correct way to code this many sebaceous cyst? The patient came in to get 18 sebaceous cyst of the scrotum removed with each measuring at 1.5 cm. He also had 1 right thigh that measured at 1 cm and a penile condyloma.

claim was billed as:
54065 dx A63.0
11401 dx L72.3
11422 dx L72.3
11422-59 ( but this was billed on a separate line 17 times) dx L72.3

Medicare denied the 11422 and all of the 11422-59 as Payment adjusted because the payer deems the information submitted does not support this many/frequency. I just want to make sure this is billed correctly before I send in an appeal to Medicare. I also wasn't sure because the 11422 without the modifier denied also. I know that per Codify this code can only be billed 3 times per day. Has anyone had this issue before?

Thanks for the help!

 

[liqgold2@aol.com]

I would bill 54060 for the single condyloma on the penis, not 54065 for extensive lesions. Part of the denial for your removal of the sebacious cysts is the fact that secondary diagnoses indicating the reason/indications for their removal are necessary for payment for the removal of sebacious cysts. Such secondary diagnoses include R23.3, L08.89, R20.8 or N50.82. I would suggest checking with the surgeon concerning the indications for sebacious cyst removal. I believe the coding as stated is correct.