Wiki CMS Malignant lesion and complex repair

[bhorncpc]

CMS is denying my complex repairs with excision of a malignant lesion. I looked up the CCI edits and they are not bundled and I can not find an LCD for First Coast Service Options with these codes.

11604
13121
13122
13122

Any input would be greatly appreciated!

P.S. In Florida, locale 99

Thanks

 

[mitchellde]

did you bill all these codes? if so why what did the note say? how long was the excision? You have indicated a huge repair for a 4 cm lesion excision so it does not add up. This is probably the same thing the payer is considering. The claim must be logical to be payable