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Necrotizing infection

E. maria Posted Thu 10th of December, 2015 16:40:56 PM

We have a Medicare patient who underwent radical debridement of right breast soft tissue infection with debridement of skin and subcutaneous tissue of 120 sq cms plus breast biopsy and breast skin biopsy. The diagnosis is N61, B95.5. Dr. is giving me CPT 19120, 11042, 11045 X5. Per Medicare, CPT codes 11042 and 11045 are not covered with these diagnosis codes. Can you suggest a better CPT code for this procedure?

SuperCoder Answered Fri 11th of December, 2015 03:06:56 AM

Thanks for your query,

Please bill these CPTs with ICD-10 code M72.6 for narcotizing skin infection.

E. maria Posted Fri 11th of December, 2015 19:49:17 PM

CCI edits is telling me ICD-10 M72.6 does not meet medical necessity for Medicare LCD's

SuperCoder Answered Mon 14th of December, 2015 04:55:47 AM


We cannot use another CPT codes instead of CPT 11042 and 11045, because the CPT is totally based on the documentation. If the documentation is specify these CPTs (11042 and 11045), then we cannot replace this with any other CPT codes in the CPT mannual.

And without documentation, it is not possible me to suggest any other ICD codes for these CPTs that would appropriate according to LCD.

You can send your report to our service SOD (Super Coding on Demand) for more help.

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