Medicaid has denied 14040 even after reading the note for this procedure. They say it needs to be recoded with the correct code. ?? 14040 is the only code billed for this procedure since the excision bundles with it. They have paid 14040 before and since, with almost the exact same documentation. The only difference on this one is the excision of the sesamoids. Not sure how that might affect it.
Any suggestions?

RESECTION OF THE DIABETIC ULCER OF THE RIGHT FOOT
There was noted ulceration on the plantar aspect of the right first metatarsophalangeal joint. Using sharp dissection, the ulceration was completely excised from the area. There was noted too what appears to be sesamoids, which were also excised from the area. The area was fully flushed with sterile saline solution.

An incision was made on the plantar aspect of the 1st metatarsal neck area to create a flap which was then advanced dorsally, and it was trimmed to fit. Tourniquet was then released with total tourniquet time of 18 minutes. By using a #3-0 Polysorb suture, capsular structures were used to cover the distal stump of the right first metatarsal. Subcutaneous tissues were then reapproximated using #4-0 Polysorb in a horizontal mattress fashion and #4-0 & #3-0 nylon were used to reapproximate the skin ends.

Appreciate the help.