Wiki Supporting diagnoses for CPT 11900 and 11901

[Sikkandhar]

Could someone please provide the possible list of diagnoses that can be covered the CPT procedure 11900 and 11901. I used 701.4 (Keloid Scar) as the covering diagnosis, but the claim was denied stating the diagnosis was not covered for the above procedure.

 

[mitchellde]

Could someone please provide the possible list of diagnoses that can be covered the CPT procedure 11900 and 11901. I used 701.4 (Keloid Scar) as the covering diagnosis, but the claim was denied stating the diagnosis was not covered for the above procedure.

Check the LCD in your region for these procedures. However you can only use the code for the diagnosis documented by the physician. The LCD will let you know when you would need an ABN signed by the patient for non medical necessity.

 

[CatchTheWind]

I don't know what region you are in, but here in Florida, there is no LCD for 11900/11901, which means there are no restrictions about what diagnosis you can use.

My guess is that the problem is not really a procedure-diagnosis mismatch, but simply that your carrier considers treatment of keloid scars as cosmetic, and therefore not covered. If there was a medical necessity, you will have to appeal with records.

(If there was no medical necessity, you can bill the patient if he signed an ABN prior to the service (or if the carrier is a commercial payer that allows you to bill the patient without any prior notice of possible non-coverage)).