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We have always billed this way to Medicare and it paid, just started receiving these denials in the last 3-4 weeks.
Any ideas.
The lesion in question shows subtle peripheral vascularity, but no filling on any phase.
The skin over the target area was cleansed with Chlorhexidine. Local anesthesia was obtained using 1% lidocaine, superficially and at depth.
Using aseptic technique, a 20 gauge core needle was advanced into the lesion under CT guidance. A total of 6 specimens were obtained from the lesion.
Next, 2 fiducial markers were placed adjacent to the lesion.
Note copied below:
Dx given in note as D49.2 and skin tags.
Scissor Snip biopsy
Left axilla x4, Right axilla x3, Groin IFEP. The area was prepped with an alcohol pad, then 1% Lidocaine with epinephrine was injected around the site(s), Scissors and pickups were used to excise the lesion at the skin surface, Monsel’s solution was applied to obtain hemostasis. The patient is instructed to notify the office if the wound site oozes, becomes painful or red. The biopsy specimen was sent to the laboratory for pathological evaluation. Left axilla x4, Right axilla x3, Groin x1
(Path came back as Groin and Left axilla as warts, and the right axilla skin tag.)
A punch biopsy tool was used to take deeper chunk of the lesion as close to base as possible. The punched piece of the lesion was then excised using forceps and scalpel. Hemostasis was achieved by electric cauterization. The open areas were then sutured back with 3.0 silk.
Plan for incision was made in the right inguinal region overlying the area of the 2 lymph nodes that had been detected on lymph node mapping. At the site of the greatest counts on the Neoprobe, an incision was made after infiltration into the skin with 0.5% sensorcaine with epinephrine. The incision was carried down through the subcutaneous tissue and through the fascia overlying the lymph nodes. The Neoprobe was used to detect a lymph node and dissection of this lymph node was performed. The lymphatic channels were clipped with Hemoclips. The lymph node was then passed off the sterile field and sent to pathology…the wound was closed in layers using 3-0 vicryl for the deep dermis and 4-0 monocryl for the skin in a running subcuticular fashion.
Provider then goes on to do an excision of a lesion on the right inner thigh.
I would appreciate any help as to what CPT would be correct regarding this type of scenario.
KM
Thanks!