Wiki benign lesion removal and insurance billing

[heatherbee]

We started a few years ago billing cyst etc removals as cash pay, they are cosmetic in nature. We have found in the past that we were simply not getting paid for them. Closure would get paid but the benign lesion codes were not and we were writing them off, so we started doing cash pay. The Practice has had a couple phones calls from insurance companies (private) that the patient complained and we need to bill the insurance. One was an HMO that in the past we would get the auth and then they would pay anyways.

How does your practice handle such removals?

Thanks

 

[Orthocoderpgu]

I can't help you with these but I have a couple of questions. If these are "cosmetic" then there is no "medical necessity", so should these be billed to insurance? You stated that closure would get paid but not the removal. Full thickness closure is included with these procedures. Layered closure may be billed separately. Are you billing closure for full thickness closure or only layered closure? Billing insurance for procedures that are not medically necessary just does not seam right to me.

 

[heatherbee]

Yes, there is no medical necessity. Patients just want them removed. We agree that they should be cash pay as cosmetic not billable to insurance. Once we bill the insurance then it is denied for medical necessity we can't bill the patient. Some had closures billed some didn't. Just wondered if anyone agreed that these shouldn't be billed to insurance. We haven't billed these to insurance in several years, just got a patient complaint and insurance call.