Shave Codes being DENIED by Medicare

LBernat7

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Wayne, PA
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Recently Medicare has been denying procedure codes 11300, 11301 etc... all the shave codes. We have never ha an issue in the past not sure what is happening now. They are stating that it is not a covered service. We have sent path reports and physician notes and they still deny. Any insite? ICD-10 codes are for Nevus- such as D22.61 or D22.5 etc they are clark's nevus and recommendations from original biopsies are to shave the lesion to the margins This is for a dermatology practice.
 
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kjbeams

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According to our Local Coverage Determination there must be another medical reason to remove a benign lesion...such as bleeding, pain, intense itching, increase in number or size? We would normally code the Nevus first and additional reason for removing second. Hope this helps!:)
 

ellzeycoding

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Recently Medicare has been denying procedure codes 11300, 11301 etc... all the shave codes. We have never ha an issue in the past not sure what is happening now. They are stating that it is not a covered service. We have sent path reports and physician notes and they still deny. Any insite? ICD-10 codes are for Nevus- such as D22.61 or D22.5 etc they are clark's nevus and recommendations from original biopsies are to shave the lesion to the margins This is for a dermatology practice.
The advice above is most likely correct. I'll provide you the link to your LCD if you let me know what state you are in.
 

LBernat7

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Wayne, PA
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11301 denial HELP

The advice above is most likely correct. I'll provide you the link to your LCD if you let me know what state you are in.
Yes please we are in Pennsylvania. The reason we would use this code is a biopsy was taken on a previous date and the biopsy which is a small sample proved that patient had a more invasive lesion that extends to one or more of the lateral margins and recommdation rom pathology (all of which we have documented and paperwork on) states a re-shave to remove the lesion to where it extends in it's entirety is recommended. We have been in practice for over 25 years and only this last few weeks has this been an recurrent denial with Medicare. We send them all paperwork and dr notes and they still deny.

Any help would be great
 
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