Wiki Bleeding skin tag

[Gator]

To accurately document medical necessity for a bleeding skin tag is it appropriate to add R58, hemorrhage NOS? I know hemorrhage is bleeding but, I always associate hemorrhage with severe bleeding. This is not what I would consider severe bleeding. Was advised to use R58 but, I'm not sure I am comfortable with that. The tag is in a very sensitive area so it is not being removed for cosmetic reasons.

 

[haraml7]

Are you documenting for medical necessity based on a denial or you would just like to submit the correct dx code for a clean claim to process?

 

[Gator]

Correct coding for a clean claim commercial insurance. Provider states in note - skin tag removal...difficulties with irritation and bleeding after intercourse....tried conservative therapy including over-the-counter freezing medication without any improvement. Just wanting to indicate on claim the bleeding part (have Dx code for the tag itself) to show it is not cosmetic and is causing problems.

 

[thomas7331]

To accurately document medical necessity for a bleeding skin tag is it appropriate to add R58, hemorrhage NOS? I know hemorrhage is bleeding but, I always associate hemorrhage with severe bleeding. This is not what I would consider severe bleeding. Was advised to use R58 but, I'm not sure I am comfortable with that. The tag is in a very sensitive area so it is not being removed for cosmetic reasons.

I believe you're being advised correctly. The Noridian LCD article A57161 lists the diagnosis for a skin tag under List II which are "conditions for which payment is allowed only if the conditions have complications, these being listed in List III" and then lists R58 as one of those conditions in List III. Since the coverage article language itself indicates that Medicare will consider removal of benign lesions to be medically necessity if the lesion is bleeding, it would be my conclusion that the R58 diagnosis is included on this list specifically for this reason. R58 is the correct code assignment for documentation of bleeding NOS and in my opinion is appropriate to report in this situation.