Wiki Lesion removal

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paula f3

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Looking for input or suggestions. I bill for a ASC , a physician did a lesion removal, with pathology coming back as lipoma. CPT code of 11406, 12032.
Dx of 214.8, V49.89. We were reimbursed from Medicare for the repair only. I called the surgeon office they were also pd for the repair only, they have gone to redetermination, but they used diag code of 216.7, V49.89, her rationale for the 216.7 was Medicare never pays for lipomas. Any suggestions, or did Medicare pay for the repair because the work units were more than the excision?

Thank you for your help
Paula
 
lipoma in muscle 214.8? Common one we use is 214.1 skin/subq....


When a lipoma is present in a superficial location, it would be appropriate to use an excision code from the integumentary system (eg, 11400-11446, Excision, benign lesion). However, when the lipoma is in a deep subcutaneous, subfascial, or submuscular location, an appropriate code from the musculoskeletal system.
 
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