Wiki Perineal mass excision getting denied by insurance

[wtcg2k]

Hello, I'm working on corrections/appeals. Insurance is denying this for the procedure being incompatible with diagnosis, but I'm not sure what should be used instead. The original coder billed this as 11423, 12042 with a diagnosis of N50.89, L02.215.

(Most of) OP note:

"[...] The patient's perineum and perianal tissue were then prepped and draped in sterile fashion. The perineal mass was palpated halfway between the base of the scrotum and the anus. Digital rectal exam revealed no induration extending to the anus. Elliptical incision was then made to encompass the mass and overlying skin with a scalpel after placing a percent Marcaine for local anesthetic. Electrocautery was then used to excise the mass from the surrounding tissue. There was significant induration and care was taken to excise all abnormal tissue to clear margins. The mass itself measured 3 cm in diameter. This was passed off as specimen. The wound was irrigated. There was good hemostasis. The 6 cm wound was then closed in 2 layers. Deep tissue was reapproximated interrupted 2-0 Vicryl sutures. The skin was then closed with a running 3-0 nylon suture. Sterile dressing was applied. [...]"

Pathology result was "Abscess with focal squamous cyst lining epithelium."


Because the mass was not actually on the genitals, is this really supposed to be 11403/12032 instead?

I'm not sure I agree with using N50.89 to describe the mass, but I don't see much that would apply to a mass of the male perineum. Maybe L72.0 to describe it more as a cyst?

Any insight would be appreciated!