Hello there, I'm new to Dermatology coding and I need help correcting a denial for an encounter. The only two codes billed were 11622 and 12042...
The denial reason is CO97 "The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated" and M15 "Separately billed services/tests have been bundled as they are considered components of the same procedure, separate payment is not allowed"
The diagnosis used was 173.42 squamous cell carcinoma of scalp and skin of neck. This is copied straight from the chart note:
Plan: Excision
Procedure Note
Location: Right mid lateral neck
Preop Size: 1.0 cm
Margins: 0.3 cm
Procedure: Excision - Elliptical
Repair Type: Intermediate
Final Wound Length: 4.5 cm
Anesthesia: local infiltration-2% lidocaine with epinephrine and a 1:10 solution of 8.4% sodium
bicarbonate(2.5 cc)
Estimated Blood Loss: minimal
Complications: none
Consent was obtained from the patient. The risks and benefits to therapy were discussed in detail.
Specifically, the risks of infection, scarring, bleeding, prolonged wound healing, incomplete removal, allergy
to anesthesia, nerve injury and recurrence were addressed. Prior to the procedure, the treatment site was
clearly identified and confirmed by the patient. All components of Universal Protocol/PAUSE Rule
completed.
Procedure: The area was prepped with Alcohol and Hibiclens. An elliptical excision was performed with a
15 blade on the Right mid lateral neck to the layer of the adipose tissue. The size of the lesion
was 1.0 cm and the margins were 0.3 cm for a total size of 1.6 cm.
Undermining was performed with blunt dissection. Hemostasis was achieved with electrocautery.
Intermediate layered repair was performed to close large gap created by lesion removal, to maintain
function in the area, to preserve normal anatomy, to reduce subcutaneous dead space to reduce risk
of hematoma, to reduce tension to skin to allow closure, to reduce tension to reduce risk of skin
necrosis, infection, and wound dehiscence, and to reduce tension to enhance both functional and
cosmetic results. The dermal sutures were 3-0 Monocryl. Epidermal closure was achieved with 4-0
Prolene (running). The final wound length was 4.5 cm. Aquaphor + bandage were applied. I reviewed with the patient in
detail
post-care instructions.
Is this denial because of missing modifiers or is this because the codes are not compatible to be used together? Please help!
Lisa
The denial reason is CO97 "The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated" and M15 "Separately billed services/tests have been bundled as they are considered components of the same procedure, separate payment is not allowed"
The diagnosis used was 173.42 squamous cell carcinoma of scalp and skin of neck. This is copied straight from the chart note:
Plan: Excision
Procedure Note
Location: Right mid lateral neck
Preop Size: 1.0 cm
Margins: 0.3 cm
Procedure: Excision - Elliptical
Repair Type: Intermediate
Final Wound Length: 4.5 cm
Anesthesia: local infiltration-2% lidocaine with epinephrine and a 1:10 solution of 8.4% sodium
bicarbonate(2.5 cc)
Estimated Blood Loss: minimal
Complications: none
Consent was obtained from the patient. The risks and benefits to therapy were discussed in detail.
Specifically, the risks of infection, scarring, bleeding, prolonged wound healing, incomplete removal, allergy
to anesthesia, nerve injury and recurrence were addressed. Prior to the procedure, the treatment site was
clearly identified and confirmed by the patient. All components of Universal Protocol/PAUSE Rule
completed.
Procedure: The area was prepped with Alcohol and Hibiclens. An elliptical excision was performed with a
15 blade on the Right mid lateral neck to the layer of the adipose tissue. The size of the lesion
was 1.0 cm and the margins were 0.3 cm for a total size of 1.6 cm.
Undermining was performed with blunt dissection. Hemostasis was achieved with electrocautery.
Intermediate layered repair was performed to close large gap created by lesion removal, to maintain
function in the area, to preserve normal anatomy, to reduce subcutaneous dead space to reduce risk
of hematoma, to reduce tension to skin to allow closure, to reduce tension to reduce risk of skin
necrosis, infection, and wound dehiscence, and to reduce tension to enhance both functional and
cosmetic results. The dermal sutures were 3-0 Monocryl. Epidermal closure was achieved with 4-0
Prolene (running). The final wound length was 4.5 cm. Aquaphor + bandage were applied. I reviewed with the patient in
detail
post-care instructions.
Is this denial because of missing modifiers or is this because the codes are not compatible to be used together? Please help!
Lisa
