# pilar cysts dx getting pd



## lindaj0317 (Feb 20, 2014)

Just wondering if anyone else is getting denials for excisions of pilar cysts (704.41).  The epi cysts (706.2) are being pd but not the pilar.  That code is not in the medicare LCD either.  Would like to know what dx code others are using instead of this one.  Inga Ellzy coding book says to just use the 238.2.


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## JesseL (Feb 23, 2014)

lindaj0317 said:


> Just wondering if anyone else is getting denials for excisions of pilar cysts (704.41).  The epi cysts (706.2) are being pd but not the pilar.  That code is not in the medicare LCD either.  Would like to know what dx code others are using instead of this one.  Inga Ellzy coding book says to just use the 238.2.



What's the denial reason? You probably need a secondary diagnosis like skin infection nos, erythma nos or disturbance of skin sensation, to specify medical necessity. That's if the denied reason is something along the lines of "not medically necessary."


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## mitchellde (Feb 23, 2014)

lindaj0317 said:


> Just wondering if anyone else is getting denials for excisions of pilar cysts (704.41).  The epi cysts (706.2) are being pd but not the pilar.  That code is not in the medicare LCD either.  Would like to know what dx code others are using instead of this one.  Inga Ellzy coding book says to just use the 238.2.



If it is documented as a pilar cyst then you must use that dx code. You cannot "manipulate" the code just to "find" one that is payable.  If it is not a covered dx then you will need an ABN and bill the patient when?if it is denied by the payer.  You absolutely cannot use the 238.2 dx code for a pilar cyst!  That is a code used when a pathologist renders that dx based a microscopic exam of the sample submitted.


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## JesseL (Feb 23, 2014)

What about 239.2 if billed without the path? I think the aapc derm books says to do it that way? And here too: http://static.aapc.com/a3c7c3fe-6fa...fb18/65d09533-8dfd-48b3-bed5-d213b80b78cd.pdf slide 4


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## mitchellde (Feb 24, 2014)

JesseL said:


> What about 239.2 if billed without the path? I think the aapc derm books says to do it that way? And here too: http://static.aapc.com/a3c7c3fe-6fa...fb18/65d09533-8dfd-48b3-bed5-d213b80b78cd.pdf slide 4



A pilar cyst is not a neoplasm. Not unspecified nor of uncertain behavior .  If the provider has documented a pilar cyst then that is what must be coded. The coder cannot determine that any other dx is more appropriate.  The dx code must reflect the patient diagnosis as rendered by the provider , always.


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## lindaj0317 (Feb 25, 2014)

It's getting denied as a non-covered service. Don't understand why they pay for epi cysts though.  We'll try to bill it as a pilar cyst with medical necessity and see if that works.  Thanks for all your help!


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