• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki medicare denial for lesion excision

Create Wiki
P

paula f3

Guest
Messages
142
Best answers
0
I have a denial from Medicare "not deemed medically necessary". Physician excised two lesions one on the scalp and the other on the leg smaller than 1 cm, pathology came back as hemangioma of scalp and leg. I coded per pathology report, 228.01.
Looking at the LCD for Az , 228.01 is not a DX for medical necessity. Is there another diagnosis I could have used? Is this a case where we should have had the patient sign an ABN? The problem is we did not know he size of lesion until after the surgery.

Paula
 
You can use V71.1 for examination for suspicious malignant neoplasm not found first listed and the 228.01 secondary, this should work with the benign excision codes.
 
You must log in or register to reply here.
Top