When is lesion excision considered cosmetic?

sara lamb

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Procedure codes 11402 exc ben lesion (shoulder area), 12031 int. rep., were denied reimbursement due to no documentation of functional impairment/considered cosmetic. The dx code was 216.6 benign neo skin (shoulder area). How else would you bill a lesion excision? Does anyone know why it's considered cosmetic?
 

rthames052006

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Procedure codes 11402 exc ben lesion (shoulder area), 12031 int. rep., were denied reimbursement due to no documentation of functional impairment/considered cosmetic. The dx code was 216.6 benign neo skin (shoulder area). How else would you bill a lesion excision? Does anyone know why it's considered cosmetic?
I have encountered this situation before, and I found out thru the insurance company and our provider rep that this is not an error on the ins company fault but some procedures they just consider cosmetic even after sending in our documentation, it's just excluded from the patients policy. The patient can appeal it but I have not seen any decision overturned yet.... I would suggest having the patients sign a waiver and/or call their insurance prior to having the procedure done.

Just giving my experience with this topic.
 

sara lamb

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Thanks so much for your input, especially checking w/ins co. & rep!--I agree with YOU :) (I have a hard time agreeing with "them" regarding proc. as "cosmetic".) ....back to the frontlines....Have a good day!
 
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