Heather Posted Mon 21st of January, 2019 15:22:07 PM
We are billing the new biopsy codes as we have always billed a biopsy code using diagnosis of 239.2/D49.2 and they are all denying since they are now on the updated LCD in 2019. How do we bill these going forward? We have always waited for a pathology report in order to bill D48.5 since that would be a path confirmed diagnosis where D49.2 is not. If we had to hold all our biopsies until a path report is back we would have to hold about 90% of our billing. Advice?
SuperCoder Answered Tue 22nd of January, 2019 06:51:50 AM
Thanks for your question.
In LCD L33445, for codes 11102-11107, ICD 10 CM code D48.5 is an applicable diagnosis code and supports medical necessity, which means it is payable.
But code D49.2 is not there in this LCD and this cannot be paid. So, you should report only those ICD 10 CM codes which are present in the LCD.
Now, to avoid denial, it is better to wait and bill only the appropriate Dx codes.
Please feel free to write if you have any question.
Heather Posted Tue 22nd of January, 2019 07:56:49 AM
What do you recommend we bill as a diagnosis for a biopsy then if we are not holding until path returns? The point of a biopsy is an unknown lesion type, malignant, benign?
SuperCoder Answered Wed 23rd of January, 2019 03:07:34 AM
As per ICD 10 CM 2019 guidelines, “If a definitive diagnosis has not been established by the end of the encounter, it is appropriate to report codes for sign(s) and/or symptom(s) in lieu of a definitive diagnosis. When sufficient clinical information isn’t known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate “unspecified” code.”
If the service is not covered under the LCD, you should provide your patients with an ABN prior to performing these services. If you have a signed and valid ABN and your office receives a denial regarding medical necessity of services, you may collect the payment from the patient's pocket for the services indicated.
Next thing you can do is you can request the payer to reconsider this ICD by sending the supporting documents.
Hope this helps.
Heather Posted Wed 23rd of January, 2019 08:00:37 AM
SuperCoder Answered Thu 24th of January, 2019 00:15:52 AM
Thank you, happy to help.