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Medicare coverage for lipoma

  1. #1
    Eugene, OR
    Question Medicare coverage for lipoma
    Medical Coding Books
    My surgeon is about to remove a lipoma from a Medicare patient. I have a list from Derm Coding Consult of Medicare-covered dx codes for skin lesions, and 214.1 (lipoma) is not on the list.(But viral warts is????) Given that the lipoma is painful and symptomatic, is there a way to code it so that Medicare will cover? 759.39 (other anomalies of the skin) is on the list, but I think it would be wrong to use the broader, unspecified code when there actually is a specific lipoma code.

    Help? Ideas? Thoughts?

  2. #2
    Hi Jensina,

    Yes, this is a delemma. First rule of thumb, code for correctness - don't code to get paid.

    Coverage for a lipoma dx code in conjunction with an excision of benign skin lesion may not be a covered benefit - it could depend on Local Coverage Determinations of your Medicare Carrier. If you get a denial, you could appeal, but who wants to go through that hassle?

    You should talk to your patient and explain that there is a chance that Medicare will not cover this procedure and then get an ABN signed. Unfortunately, the prospect of having to pay out of pocket for this will probably scare your patient away.

    P.S. - If your patient decides to go ahead withthis procedure, remember that if your physician does more than a simple closure, you may code intermediate (12031- 12-57) or complex (13100 - 13160) repairs in addition to the excision.

    Good luck.

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