Wiki Hair Loss and Denials

[ltl226]

Hello,

We have been seeing denials for procedures and labs billed with hair loss codes. For example - Intralesional injection (11900) billed with diagnosis L65.9.

I have am meeting with a provider regarding this and wonder if anyone has any experience with denials and diagnosis of hair loss? Any information would be greatly appreciated.

Thank you,
Laura

 

[thomas7331]

Treatment of hair loss is often excluded from coverage by many payers because it is considered cosmetic rather than medically necessary. Each payers will usually have their own policy for this - some may cover it only for specific conditions or certain diagnosis codes. Some may cover the diagnosis on an E&M visit but may exclude coverage of the treatments for the condition. It all really depends on the payers and on the patient's own plan benefits. As a starting point, I'd recommend taking looking at the policies on the web sites of the payers to which your practice submits its highest volumes of claims. If you're able to identify in advance that a treatment is likely not going to be covered for a particular patient, you can request that the patient sign a waiver to agree to make payment in the event that the insurance does not cover it.

diagnosis codes, diagnosis coding