Wiki esthetician to do Acne Surgery 10040 bill to insurance?

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LBernat7

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We have an esthetician that was told she can do Acne Surgery on a patient CPT code10040 and it be summitted to ins and covered. She currently does what fits the description of that code but for cosmetic reasons obviously. Someone told her ins would cover it. I have seen the code summitted by Physicians and it be covered.
 
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LBernat7 said:
We have an esthetician that was told she can do Acne Surgery on a patient CPT code10040 and it be summitted to ins and covered. She currently does what fits the description of that code but for cosmetic reasons obviously. Someone told her ins would cover it. I have seen the code summitted by Physicians and it be covered.
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Your question is confusing - if it is being done for cosmetic reasons, then it is not acne surgery, so this code wouldn't apply. To misrepresent a cosmetic procedure as medically necessary acne surgery on an insurance claim could potentially be fraudulent. Can you give more details about what is being performed? Whether or not the code is appropriate is going to depend on documentation.
 
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If she is doing it for cosmetic purposes, then the diagnosis is "cosmetic" and insurance won't cover it. If it was ordered by a doctor for treatment of the acne, then the diagnosis is "acne" and it can be covered.
 
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