Here is one of some scenarios:
A medicare patient has a mildly enlarged digital mucous cyst of the right distal radial thumb. The doctor decides to perform an incision and drainage. He reported CPT code 10060 with ICD 10 CM code M71.341. The diagnosis code is not on the LCD or MCD for Incision and drainage. I have attached the article A56766. You can see that nothing remotely to a cyst like the one described above is on this list. This will get denied even if a symptom code is added. The documentation requirements are included in the article. The doctor documents almost completely. He left out the measured amount that he drained from the cyst. The inadequate documentation causes me to refrain from appealing this and some others like it that have been denied.
In the past few years, I have tried educating the providers about this particular coding situation and about appropriate/required documentation. And the only idea I have left, is to tell them to either include the I & D in the E/M or refer the patient to a hand surgeon.
Has anyone else come across this type of scenario? If so, do you or anyone, have any insight that you could share?
I look forward to some insight.
Thank you.
Andra
A medicare patient has a mildly enlarged digital mucous cyst of the right distal radial thumb. The doctor decides to perform an incision and drainage. He reported CPT code 10060 with ICD 10 CM code M71.341. The diagnosis code is not on the LCD or MCD for Incision and drainage. I have attached the article A56766. You can see that nothing remotely to a cyst like the one described above is on this list. This will get denied even if a symptom code is added. The documentation requirements are included in the article. The doctor documents almost completely. He left out the measured amount that he drained from the cyst. The inadequate documentation causes me to refrain from appealing this and some others like it that have been denied.
In the past few years, I have tried educating the providers about this particular coding situation and about appropriate/required documentation. And the only idea I have left, is to tell them to either include the I & D in the E/M or refer the patient to a hand surgeon.
Has anyone else come across this type of scenario? If so, do you or anyone, have any insight that you could share?
I look forward to some insight.
Thank you.
Andra