04/20/2022

Fidelis Denial for CPT 11055

fidelis is denying using dx code I70.203. they say the dx code is wrong. should i add L84?

I70.203 is a valid ICD-10 diagnosis code for atherosclerosis, this can be billed to any insurance carrier when necessary for routine foot care services. If the removal of corns and callouses has been denied by Fidelis Care, further research should be done to confirm if the charge was denied because the patient’s plan only covers certain systemic conditions in order for routine foot care to be covered (such as diabetes). If the denial for the charge is not associated with a policy limitation, the denial should be appealed with the Managed Care Plan. If care was provided per Medicare guidelines, there is no valid reason on why the charge should be denied as non-covered. Adding ICD-10 code L84 would be a non-event in regard to the denial- adding it to the claim would not impact the adjudication since the focus is on the systemic condition to justify medical necessity.