Wiki Diagnosis help

[andersont]

We are dealing with a lot of Medicare patients coming in for cyst removals (Epidermal, sebaceous, etc). We have the patient sign an ABN. Most of these cysts are painful, inflamed or infected. What diagnosis can I include with the primary dx.?

 

[ellzeycoding]

R20.3 = painful (hyperesthesia)
R58 = bleeding (hemorrhage)
L53.9 = reddening/(inflamed?)
L08.9 = infected

These codes are often in the benign skin lesion removal policies for many carriers

 

[andersont]

Thanks for your help

CPT 11402 was billed and denied because I had the dx L72.0 and no additional code. I am not understanding how to use the LCD's. I know the L72.0 wasn't listed in list one, but didn't see anything in list II to use. Can I use the cyst dx and then a code from list III?

 

[ellzeycoding]

LCDs do vary by carrier, but depending on the actual LCD, most have instructions above the listings of each code.

Sometimes it's one list and all ICD-10 codes are covered

Some of List I, List II, and List III. For these usually List I are covered by themselves. List II codes are covered when a secondary code from List II is coded in addition to the primary ICD-10 code.

An example is here...

https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=34233


It states...

Group 2 Paragraph: List II. These ICD-10-CM codes identify those conditions for which payment is allowed only if the conditions have complications, these being listed in List III below.

Note: Diagnoses from List II must be accompanied by one of the diagnoses from List III for payment to be allowed. List III gives justification (reasonable and necessary) for allowing payment.

So L72.0 is listed in Group 2, so a code from Group 3 must be coded secondary to show medical necessity.