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