Wiki 11400 denial

[jhastings]

Insurance is denying code saying this has an age range from 0-20. Can someone please tell me where in the code book this is stated? I looked and don't see it.

thanks

 

[danachock]

Hi jhastings,
I almost believe what they are denying you for is possibly the diagnosis code. What was assigned?
Thank you for listening and have a fantastic evening,
Dana

 

[twizzle]

Yes, per the previous request, please tell us was ICD-10-CM code was used. That way we may be able to help you.
11400 has no age restrictions.

 

[jhastings]

Hi jhastings,
I almost believe what they are denying you for is possibly the diagnosis code. What was assigned?
Thank you for listening and have a fantastic evening,
Dana

Hi Twizzle,

The DX I used was L72.3 on the claim.

 

[fami]

Insurance is denying code saying this has an age range from 0-20. Can someone please tell me where in the code book this is stated? I looked and don't see it.

thanks

Hi ,
description of the code is
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less

 

[twizzle]

You probably need to query the payer because neither the CPT code nor the ICD-10 code are age-specific.

 

[julieordway]

I agree with twizzle. These codes pair and there are no age restrictions. I would make a call to the payor. If all else is clean and correct on the claim, this sounds like a insurance processing error.

 

[amyjph]

I think there could be something else going on here. What are the demographics on the claim? How old is the patient? Were there any other CPT or diagnoses on the claim? Was the place of service office? It's difficult to answer this type question without more info. Was what was entered in the billing system definitely what went out on the claim?
If it was a sebaceous cyst was it really excision (full-thickness (through the dermis) removal) for sure or was it I&D?