Wiki Claim Edit Rationale

[lindam@caricures.com]

I work for a colon rectal surgeon. He has a patient that has dysplasia of the anus. He removed some skin lesion - I used 11401 - with Dx code K62.82. My claim is being denied as the diagnoses and the procedure do not appropriately correspond. I am looking for any help I can get. The insurance refers me to CMS.GOV. 11401 is in Group 1 for CPT/HCPCS Codes. K62.82 is in Group 1 of ICD 10 Codes. I'm not sure what I am doing wrong.

 

[sls314]

I work for a colon rectal surgeon. He has a patient that has dysplasia of the anus. He removed some skin lesion - I used 11401 - with Dx code K62.82. My claim is being denied as the diagnoses and the procedure do not appropriately correspond. I am looking for any help I can get. The insurance refers me to CMS.GOV. 11401 is in Group 1 for CPT/HCPCS Codes. K62.82 is in Group 1 of ICD 10 Codes. I'm not sure what I am doing wrong.

Which MAC is applicable for the service area? Are you looking at the correct LCD?

For the Novitas LCD, 11401 is a Group 2 CPT code, and K62.82 is not a Group 2 diagnosis.

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=57113

 

[lindam@caricures.com]

Which MAC is applicable for the service area? Are you looking at the correct LCD?

For the Novitas LCD, 11401 is a Group 2 CPT code, and K62.82 is not a Group 2 diagnosis.

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=57113

We are in Pennsylvania. Thanks for the info. I am brand new this and learning every day. How did you look up the information you found?

 

[lindam@caricures.com]

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=57482&ver=18&bc=0

this was the article I was looking at. Which I guess is wrong since it says Wisconsin. Oh boy, I have a lot to learn

 

[sls314]

We are in Pennsylvania. Thanks for the info. I am brand new this and learning every day. How did you look up the information you found?

The CMS website has a searchable Medicare Coverage Database (MCD), where you can find all of the NCD and LCD. On the site, you can search by code or keyword, and also filter your results to only show the LCD that are applicable to a specific state:

https://www.cms.gov/medicare-coverage-database/search.aspx

 

[lindam@caricures.com]

Thank you