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Wiki Soft Tissue Radionecrosis

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stogsmom3

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I know we don't code to get paid. But, I go around and around with coding Soft tissue Radionecrosis. I code for a Wound Clinic. If I code as L59.8, the HBO gets paid but the debridement is denied for medical necessity. L59.8 isn't listed on the LCD for debridements. I just need advise, to code correctly. If I start at necrosis and look for radiation, it states to see Necrosis by site. There is no soft tissue, but there's subcutaneous newborn. Skin or subcutaneous states I96. So, then I confirm in the tabular section to find, I96 = Gangrene. So now, I'm confused. The note doesn't mention Gangrene. If I start with Radiation, Sickness then the tabular states excludes radiation related disorder of the skin and subcutaneous tissue. So, now I'm back to L59.8. Please help!
 
re: radiation lesions

FYI- MCR will only pay for L59.8 not the L59.9 anymore, for HBO; The NCD 20.29 has both (for HBO). This code will not get paid for debridement, as they are ulcers not wounds- you must add the L97/L98 code for location and severity to go with each documented wound. Apply the debridement to the L codes.
 
Radiation ulcers

per Medscapes article Dated 3/15/2016 Radiation (lesions) are ulcers caused by acute or chronic effects of radiation ~~ given the progressive nature of radiation damages, a soft tissue ulceration may develop at any time after radiation exposure. these are ulcers apply the L97 /L98 codes, rather than wound SXX codes and your debridement will be authorized and paid.
 
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