Medicare Compliance & Reimbursement - 2011 Issue 12
Reader Questions: Secondary Dx May Be Required With 702.11, 702.19
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Article Overview
This article addresses a coding question involving a benign lesion excision, payer denial, and diagnosis support for medical necessity. It is aimed at coders and billing staff who work with skin lesion procedures, pathology-supported diagnoses, and claim edits involving primary and secondary diagnosis requirements. The discussion references diagnosis coding choices, procedure code selection, and payer policy considerations at a general level.
Why This Topic Matters
Skin lesion claims are often scrutinized for diagnosis support, documentation alignment, and correct procedure reporting. Understanding the issue helps coders recognize when claim denials may be related to diagnosis sequencing, medical necessity rules, or procedure code selection.
What You Will Learn
- How diagnosis support can affect payment review for a benign lesion excision
- How documentation and pathology findings relate to claim submission issues
- How procedure code selection is part of the claim review process for this type of service
- How payer policy or LCD-related edits can influence denial resolution
Who Should Read This
- Medical coders
- Billing specialists
- Revenue cycle staff
- Physician office staff
- Dermatology coding professionals
Codes Discussed
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