Trying to get 11420 covered by Medicare any thoughts?

Mar 27th, 2012 - nmaguire 2,606

re: TRYING TO GET 11420 COVERED BY MEDICARE ANY THOUGHTS?

What is the diagnosis code? Why are they denying?

Mar 27th, 2012 - aewells 21

re: TRYING TO GET 11420 COVERED BY MEDICARE ANY THOUGHTS?

ICD is 709.9. They denied saying it is a non-covered charge. I do have Dr. notes supporting the fact that it is painful as it catches on his clothing. Do you think I could just resubmit along with the Dr. notes?

Mar 27th, 2012 - youngblood 278

re: TRYING TO GET 11420 COVERED BY MEDICARE ANY THOUGHTS?

You can try an appeal with notes. This group of codes are often considered "cosmetic" in initial adjudication.

Mar 27th, 2012 - nmaguire 2,606

re: TRYING TO GET 11420 COVERED BY MEDICARE ANY THOUGHTS?

Your diagnosis code is not one that is covered for that procedure. Look to your Medicare carrier's LCD for specific diagnosis codes that are reimbursed.

Mar 27th, 2012 - aewells 21

re: TRYING TO GET 11420 COVERED BY MEDICARE ANY THOUGHTS?

If iI used ICD 216.4 and CPT® 11420 should I still send along the supporting Dr. notes?

Mar 27th, 2012 - nmaguire 2,606

re: TRYING TO GET 11420 COVERED BY MEDICARE ANY THOUGHTS?

Add a secondary code for complication, if documented. Example: There is drainage, inflammation, bleeding, burning, intense itching, or pain associated with the lesion.
• The lesion is growing in size.
• The lesion obstructs a body orifice, restricts vision or otherwise significantly interferes with normal function.
• There is clinical suspicion of malignancy (e.g., a change in the ABCDs of skin cancer [asymmetry, border irregularity, color, and diameter]).
• Due to its anatomical location, the lesion is prone to being recurrently traumatized.

Mar 27th, 2012 - aewells 21

re: TRYING TO GET 11420 COVERED BY MEDICARE ANY THOUGHTS?

Thanks so much!!! Have a great night!!

Mar 27th, 2012 - nmaguire 2,606

re: TRYING TO GET 11420 COVERED BY MEDICARE ANY THOUGHTS?

You are welcome

Mar 28th, 2012 -

re: TRYING TO GET 11420 COVERED BY MEDICARE ANY THOUGHTS?

709.9 is a payable dx, but if you look at the medical review policy you also have to
have a secondary dx before Medicare will pay.
Dx area 279.
338.19 other acute pain
682.0 thru 682.9
686.8 686.9
729.5 pain in limb
782.0 disturbance skin sensation

the medical review policy is LCD number L31895 Removal of Benign Skin lesions