Forum - Questions & Answers

Sep 6th, 2011 - Shannan 28 

11406 CPT® Denial

I have a claim that was denied. The CPT® is 11406 with a dx 702.19. It is denying for medical necessity. EOB states that the secondary diagnosis code on the claim line is missing or does not meet medical necessity for procedure code. How do I fix this? There is no secondary dx.

Thank You

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Sep 6th, 2011 - jschmutz   323 

re: 11406 CPT® Denial

We can't really help you unless we know who the Medicare carrier is that denied the claim. Or you can look up the LCD yourself on the CMS website.

https://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx?kq=true

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Sep 6th, 2011 - Shannan 28 

re: 11406 CPT® Denial

The medicare carrier is Secure Horizons PFFS

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Sep 6th, 2011 - TerryC 39 

re: 11406 CPT® Denial

My opinion would be to use 17110 destruction of benign lesions. However it would also depend on how it was removed. If it was actually "cut/excised" I would think the 11406. The 17110 has several different ways of removal (you can look under the code for descriptions) or if is was shaved the 11300 codes depending on size and location. Hope something helped.

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