Mycosis

espforu

Guru
Local Chapter Officer
Messages
140
Location
NAPLES, FL
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Medicare is denying our visits for not medically necessary for 110.9 and 111.9.

It does not seem correct as these were office visits and the provider did prescribe treatment. Since I normally do not handle derm maybe the experts can help me :)? Doesn't seem quite right.

I did try to see if I could find something on the CMS website but since these are only office visits, I could not locate anything.

Can anyone direct me to any references?

Thanks!

Happy Coding! :)
 

mitchellde

True Blue
Messages
13,490
Location
Columbia, MO
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1
It is entirely possible that it is being denied due to the use of unspecified dx codes. You should check the documentation to see if it is possible to be more specific.
 

espforu

Guru
Local Chapter Officer
Messages
140
Location
NAPLES, FL
Best answers
0
Thanks, the only thing the documentation says is "fungal lesion on lateral aspect of left ankle"

I am unsure how the provider determined it as "fungal" there is no confirmation by lab that it is a "fungal lesion" unless by visual exam? I am not a clinician so I am not sure if this can be determined by looking.

The provider is the coder.
 
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