Forum - Questions & Answers

Dec 1st, 2020 - sschwartz 4 

If you know a procedure will be denied as cosmetic can an E/M be charged instead?

If a patient comes in for foot pain, thinking she has an dog hair in her foot, but upon exam the provider says it's corns and shaves them down and tells her to use a pumice stone and discussed poorly fitting shoes etc...Can an E/M be charged with dx for left foot pain, instead of L84 corns and callosities with CPT 11055 (parring or cutting of benign hyperkerotosis) which insurance will deny for both the dx and cpt? The CC says "left foot swollen" with additional complaint stating "here today for left foot pain", HPI states patient there for left foot pain, exam says "two corns on sole of left foot exactly where pt indicates pain", and assessment says "shaved down corn on left foot using dermablade. Pt reports no pain after procedure, recommend use of pumice stone regularly, discussed friction poor fitting shoes. …" Does the procedure and corn have to be coded ad that was provider's final decision even knowing they will deny or can an E/M with dx for left foot pain be used instead?

Dec 7th, 2020 - ChrisW   256  1 

re: If you know a procedure will be denied as cosmetic can an E/M be charged instead?

It is only appropriate to code what has actually been done, whether it is a paid benefit or not. In this situation, an ABN should have need used, and the pairing or cutting with L84 should be reported to avoid submitting a fraudulent claim. I would refer you to review the policy on foot care for the payer.

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