Wiki atypical nevus removal

[andersont]

HELP!!! I don't fully understand how to read the LCD's for Medicare. My understanding when billing 11200-17111 only the codes in group one are the only ones covered. The dx I have isn't in that list, but it is listed in Group 2 codes D22.4 and D22.61

How do I get MC to pay for atypical lesions with the dx of D22.4 or D22.61? Is the add on code supposed to be Z78.9? Can we have the patient sign an ABN for atypical melanocytic nevi removal? The pathologist require these be excised.

HELP!!!

 

[mitchellde]

If the diagnosis is documented as atypical melanocytic Nevi of skin, the Dx code would be D48.5. Stating atypical is equivalent to uncertain behavior.

 

[ellzeycoding]

D48.5 would be correct as Mitchellde stated

In regards to the LCD, some carriers have DX listed in Groups 1, 2 and 3. Group 1 codes are typically covered by themself (like D48.5).

If you read the Indiciations for Coverage or the headings in each Group in detail, you usually find that the Group 2 codes are covered if a secondary code from Group 3 is coded (and applicable). This usually applies when the Group 2 code is required to have medical necessity condition like bleeding, painful, itching, inflamed etc. For example, there are R-codes towards the bottom of the Group 3 list that equates to bleeding, irritated, painful, etc.