Venous Hypertension Ulcer ICD-10

stogsmom3

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I'm coding for debridements for a wound clinic. The patient has a debridement of venous hypertension ulcer of right leg. The code I87.31 and I87.33 aren't listed on the LCD. Any suggestions with dealing with these denials?:confused:
 

thomas7331

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If you're just using the I87 codes alone, the coding isn't complete and that may be causing your denials. I87.31X and I87.33X codes require an additional code from the L97 range to describe the location and severity of the ulcer.
 

thomas7331

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What are the CPT and diagnosis codes you're billing, and which MAC is denying them for what reason? L97 wound codes should support medical necessity and be covered for most debridement services as long as you're not using unspecified codes. Some MACs will deny if you are using unspecified codes (e.g. unspecified location or severity of the wound).
 

stogsmom3

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I've received denials with and without the unspecified severity of the ulcer. They are denials by WPS. Which these codes aren't listed on the LCD. But, on would think it would be listed due to the fact that it includes the word ulcer. For example, I87.311 and L97.812 has been denied due to not medically necessary. But, the I87.2 is listed on the LCD. I don't feel its correct to code I87.2 when there is a combination code that includes the venous insufficiency. Any thoughts?

Thanks
Melissa
 

stogsmom3

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Venous hypertension ulcers

I'm still looking for more advice. I code for the professional services for Wound Care. We are in J8 MAC. I don't understand why the venous hypertension ulcer coding isn't listed on the LCD for debridements.

For example: Venous Hypertension Ulcer to the Right Heel without inflammation with a severity of fat layer exposure. I would code as I87.311 with L97.412. These are always denied. I feel it would be wrong to add I87.2 as the primary diagnosis since this would be part of the disease process. I know the hospital codes with the I87.2 as primary and gets paid. But, we were taught that we don't code to get paid.

Any thoughts would be greatly appreciated.
 

mjstack

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I code for the professional claims for Wound Care for Central Florida; The caveat here, is if dr lists both I87.2 or I73.9 and the more definite dx, rather than just the condition, is do not bill both. I also do not assign any E11, I70, I87, I83 to the actual debridement cpt code. I assign the secondary location/severity code, the others are listed on the claim . As FYI only- Wellcare has been denying some claims that have both I87 & I83 codes as bundled? as well as Humana denying if you put I87.311 & I87.312 instead of the bilateral code I87.313. Maybe its the payer issue instead of guideline issue?
 
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