01/25/2021

Excellus Denial for ICD-10 L98.8

I have a patient with diagnosis of painful Piezongenic Papule. I gave the patient an injection delivered into the piezogenic papule and surrounding fat pad consisting of 0.5 cc of 2% lidocaine plain, 0.5 cc of .5% Marcaine plain and 1 cc of dexamethasone sodium phosphate 4 mg/cc (1 unit). His Excellus insurance is denying this based on the diagnosis code we used of L98.8 as not covered (other specified disorders of the skin and subcutaneous tissue). What diagnosis and procedure code should I use?

Excellus denied this code correctly due to the reported diagnosis- the insurance’s administrative policy has a wide range of diagnosis codes that are covered for the injection code used. Below is the link with the diagnosis codes from their policy. Documentation should be reviewed to see any support billing any of the listed diagnosis, then a claim can be submitted as a corrected claim with supporting documentation. 

Exc Prv Therapeutic Injection Icd 10 Code List Ap 09 Effective 8 21 2020