rkindlund
Networker
I am wondering about how to code medical necessity for benign skin lesions for Medicare. LCD L34233 (Noridian) says the following:
Medicare will consider the removal of benign skin lesions as medically necessary, and not cosmetic, if one or
more of the following conditions is present and clearly documented in the medical record:
A. The lesion has one or more of the following characteristics:
1. bleeding
2. intense itching
3. pain
However, the secondary ICD 10 codes in List III of the LCD are so specific they don't necessarily address these, specifically "pain." If my provider notes that a sebaceous cyst is painful/irritating to the patient, that is medical necessity according to the LCD, but none of the codes in List III are about pain or irritation in general. I don't know how to code these so that Medicare will pay.
Any ideas? There used to be a Z code (if I remember right) that was a catch-all for medical necessity in these types of cases, but I don't see it on the LCD anymore.
Medicare will consider the removal of benign skin lesions as medically necessary, and not cosmetic, if one or
more of the following conditions is present and clearly documented in the medical record:
A. The lesion has one or more of the following characteristics:
1. bleeding
2. intense itching
3. pain
However, the secondary ICD 10 codes in List III of the LCD are so specific they don't necessarily address these, specifically "pain." If my provider notes that a sebaceous cyst is painful/irritating to the patient, that is medical necessity according to the LCD, but none of the codes in List III are about pain or irritation in general. I don't know how to code these so that Medicare will pay.
Any ideas? There used to be a Z code (if I remember right) that was a catch-all for medical necessity in these types of cases, but I don't see it on the LCD anymore.