Benign Lesion Removal: I am a North Carolina provider, and I am having trouble getting my claim for benign lesion removal paid. Why?
The North Carolina local medical review policy for removal of benign lesions was revised late 2002. Diagnoses for warts and seborrheic keratoses and sebaceous cysts were added, but providers were instructed modifiers would be necessary for payment. Removal of benign lesions including the above types would be considered cosmetic unless there was medical necessity for removal as evidenced by the presence of one or more of the following: • The lesion has one or more of the following characteristics: 1) bleeding; 2) intense itching; 3) pain. • The lesion has physical evidence of inflammation, e.g., purulence, oozing, edema, erythema, etc. • The lesion obstructs an orifice or clinically restricts vision. • There is clinical uncertainty as to the likely diagnosis, particularly where malignancy is a realistic consideration based on lesion appearance. • The lesion is in an anatomical region subject to recurrent physical trauma and there is documentation that such trauma has in fact occurred. •
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- Benign Lesion Removal: I am a North Carolina provider, and I am having trouble getting my claim for benign lesion removal paid. Why?
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