# AT A LOSS, Please Help



## nelstx2 (Jan 28, 2014)

Coded as 99214 -25 and 11404, being denied  Should I have coded as 11000?
PROCEDURE IN FULL;
LOCATION:lower back;inferior aspect of surgical incision at approx L4-5
SIZE:Incision OS 2mm;tract 1.2cm;
REASON FOR SURGERY:Recurrent cellulitis/drainage of surgical wound;r/o FB/suture tract
After betadine prep the ltissue was infiltrated w/ xylocain 2% w/ epi. Following adequate local analgesia the 2mm pore was excised in an elipitical fashion and the central core followed down to the fascia where it terminated at 1.2cm in depth;the area ws debrided until smooth then irrigated w/ NS x 60 cc;The wound was then loosely closed w/ a mattress using 4.0 and two sperficial interrupted sutures;this is not drawn tight to allow drainage
SUTURE: Prolene 4.0
SPECIMEN SENT TO PATH: yes
A/P # incision infection POSTOPERATIVE INFECTION (998.59.):
# SUPERFICIAL FOREIGN BODY (SPLINTER) OF TRUNK WITHOUT MAJOR OPEN
WOUND INFECTED (911.7):


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## ngeorge05 (Jan 28, 2014)

*11404 vs. 11000*

Hi nelstx2,

What was the denial reason you got? Curious to know but I don't think that the 11404 would not be appropriate for the diagnosis. This category is for excision of benign lesions, the note is in regard to an infection.


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## ohiocoder101 (Jan 28, 2014)

*Wrong Forum*

Hello, 

You may get more responses if you post under a specialty or in the general discussions. This forum is primarily for job related posts.

Good Luck

Thanks, 
Julie


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## OCD_coder (Jan 28, 2014)

This is a basic postop I/D = 10180. 

I can't comment on the E&M as only the Op Report information was shared.  There is no documentation to support a FB removal (we don't code R/O rule outs) when a removal was not performed, 998.59 only.


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## Pam Brooks (Jan 29, 2014)

This is an I&D, not a benign lesion removal.   Also, billing an E&M with a minor surgery is tricky these days.   Check the CCI Edits.  Even appending the -25 with a minor procedure won't guarantee payment. What/when was the original procedure?  Are you bumping up against global days?  What was the denial reason?


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## nelstx2 (Jan 29, 2014)

DOS is 11/14/13, was denied for Medical necessity (medicare patient)  looked in the LCD-24361-   this was a removal of a suture 11 months after a surgery....

History of Present Illness: Nurse med Check :UTD, pt has extreme pain in his left leg radiating from his back
LOWER BACK INCISION:recurrent drainage--suspect retained sutures w/ tract;The pt had surgery on 1/17/13 for a decompressin laminectomy by Dr XXX ;Since then he has had severarl episodes of drainage from the lower aspect of the incision that repsonded to antibitoics for a short time then recurred;This last month it did not resolve and it was decided to remove area of drainage;


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## nelstx2 (Jan 31, 2014)

Thank you for your help,


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