Wiki medicare denial for lesion excision

[paula f3]

I have a Medicare claim that is being denied for medical necessity. Physician remove 2 separate lesions less than 1cm. I always wait for a pathology report, in which in this particular case pathology came back hemangioma , I used DX coded 228.01, V71.1.
I called the surgeon's office and they used 226.1, V49.89. The surgeon's office stated that she never waits for a path report. Their biller is stating that they have been paid.
How would one know to code a benign lesion or malignant lesion unless you had a path report?

Your help is appreciated.

Paula

 

[mitchellde]

You are correct that an excision cannot be coded without a path report. The only thing wrong with your codes is the V71.1 must be first listed, this may be why you received a denial. The code the physician office gave is incorrect in the 226 is a three digit code. And there is no justification for the V49.89.