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Chris Posted Thu 17th of February, 2011 16:36:21 PM

Excision of lipoma on scalp post left post-auricular area. Dr wrote Excision of lipoma. Area at the borders of the 3cm lipoma is anesthetized with 10cc plain lidocaine. Elliptical incision is made and fatty tissue is dissected out without complication. Incision is closed in one layer with 2-0 Ethilon.
I show it as 21012 and that shows that it is only a facility code in our BCBS in AR. But elsewhere it shows for facility and non facility. It was done in the office in our surgical room. It was 3 cm. How should I code this so that I am coding correctly? Or should I have coded this as a bening excision removal?

Chris Posted Thu 17th of February, 2011 17:09:58 PM

Lipoma Correction on typing error. 21012

SuperCoder Answered Thu 17th of February, 2011 18:56:28 PM

If 21012 is only a facility code as per BCBS, then it is highly probable that you will be getting a denial for this being perfomred in a non-facility. Crosscheck with Insurance rep again regarding this issue.

We can resort to many other options once we get info from insurance rep, so as to get reimbursement.

Chris Posted Thu 17th of February, 2011 19:16:54 PM

I have checked with the insurance rep in our office. She says this patient is a Medicare patient. But in our state BCBS processes the Medicare. But the Blues are to go by Medicare rules. Please advise me at this point I am so confused. Should I file and get the denial? or should I ask for another option and go with that? By your chart it shows Medicare 21012 both Medicare facility and non facility.

SuperCoder Answered Thu 17th of February, 2011 19:25:51 PM

For the first time I think there should not be a denial by billing it for non-facility. In this case of a denial we can handle further in proper manner.

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