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.
- ICD-10 Trainings
- Comprehensive Courses
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder) NEW!
- CRC (Certified Risk Adjustment Coder) NEW!
- CPB (Certified Professional Biller)
- CPMA (Certified Professional Medical Auditor)
- CDEO (Certified Documentation Expert – Outpatient) NEW!
- CPPM (Certified Physician Practice Manager)
- CPCO (Certified Professional Compliance Officer)
- VIEW ALL CERTIFICATIONS
Coding / Billing Solutions
- Audit / Compliance Solutions
Job Experience / Apprentice Removal
News / Discussion
- Other Resources
- Book Store
- Log In / Join