01/21/2021

Correct Billing for CPT 10140

I have billed Medicare for CPT code 10140 - I and D of hematoma using ICD - 10 M79.81 which got denied as non-covered service not deemed a medical necessity. Is there a more specific diagnosis code to use to get paid?

NGS Medicare has a coding article that specifies covered diagnosis codes for I&D procedures. ICD-10 M79.81 was denied correctly as a code that is not medically necessary. At a high level review, the following conditions would be covered:

• Abscesses & cellulitis
• Contusions
• Crushing injuries
• Post-op infections

Attached is the link with the complete list of covered diagnosis codes that justify medical necessity:

 https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleid=56766&ver=10&keyword=&keywordType=starts&areaId=all&docType=6,3,5,1,F,P&contractOption=all&hcpcsOption=code&hcpcsStartCode=10140&hcpcsEndCode=10140&sortBy=title&bc=AAAAAAQAAAAA