Wiki Mycosis

[espforu]

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]

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]

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.