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!
Click here for more sample CPC practice exam questions with Full Rationale Answers
Laureen shows you her proprietary “Bubbling and Highlighting Technique”
Download your Free copy of my "Medical Coding From Home Ebook" at the top right corner of this page
Tag Archives: Radionecrosis
Radiation Proctitis vs. Soft Tissue Radionecrosis
I have a physician that is ordering Hyperbaric Oxygen Therapy for a patient with documented radiation proctitis. He is arguing that radiation proctitis is the same thing as soft tissue radionecrosis, and he is wanting to bill with L59.8 (specified disorder of skin and subcutaneous tissues related to radiation) instead of K62.7 (radiation proctitis). I understand that L59.8 is payable for HBOT, but I’m having trouble finding anything to support whether or not this is an accurate diagnosis for what is actually happening with the patient. We are under the NGS MAC. Can anyone offer any resources or advice? Thank you.