Wiki Excision sub-q sebaceous cyst / scalp

[JoannaWelch]

description of procedure: 4 incisions were made and each subcutaneous sebaceous cyst (1.5 cm each) was excised. closure performed with 4-0 ethilon in an interrupted fashion. I billed to BCBS: 21011 on first claim line with 21011 on the next 3 claim lines all with modifier 59, and dx code L72.3. Path says sebaceous cyst. Does this sound correct? Should I use dx L72.8?

 

[CodingKing]

I'm curious why you are thinking other code? Is it the word Subcutaneous? L72.3 says "Sebaceous cyst" They physician removing them is calling them Sebaceous cyst and pathology supports that DX.

 

[JoannaWelch]

the claim is showing on my rejection report and I feel confident of the CPT code, so I guess I'm just assuming its the dx code.......... and yes, its says sub-q I think the claim is correct but am second guessing myself and need a 2nd opinion. Thanks!

 

[CodingKing]

Maybe they are thinking its cosmetic? Reading up on these they don't need to be taken out unless they are getting, inflamed or infected. Maybe it needs an additional diagnosis to show medical necessity like with skin tags? The MUE is 4 so it cant be that.