Examples:

Patient A had fat necrosis of breast and h/o adenocarcinoma. The insurance rejected once for the fat necrosis (N64.1) so we looked further into the op note and we used N63.21, unspecified lump in left breast. The insurance denied it again for the N63.21. We have also changed the order of the dx code…trying once with the history Z code first, once with the N code first, and the insurance rejected both. We thought about removing the LT modifier off of the CPT, since the diagnosis code includes the laterality? This was all for a removal of a breast lesion.

Patient B has C50.112 as a diagnosis for a partial mastectomy, the insurance rejected the ICD code.

Anyone else been having trouble with any of these codes? I know the N63.2- area is all unspecified, so we thought that could be part of it. But the C50.112 is fairly specific.

I know Medicare was having issues with this but both of these cases are other insurances. One is a BCBS and one is United HC.

Thanks in advance for any help!