Wiki Horizon BCBS audit

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drampas3418

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does anyone have any insight into an audit from BCBS? i have just been through one and i did appeal their findings and was still shot down.i am being told this is a final determination...specifically they are taking back monies paid on codes 17000 and 17003 due to incomplete documentation..per the auditors for bcbs all lesions must contain the size of the lesion and since ours did not , they are taking back money...supposively the auditors are all either cpc or ahima(?) coders and know what they are doing. well i beg to differ. no documentation as far as size is needed for Aks...so i begin a fight...anyone have any input?
 
you may not need the size but you do need confirmation that they are AKs. 17000 and 17003 do not go by size but they do need proof that this is a premalignant lesion.
 
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