Medical Billing Forum

Coding => Coding => Topic started by: JSANDERS32 on July 14, 2010, 07:58:04 AM

Title: CPT 17106
Post by: JSANDERS32 on July 14, 2010, 07:58:04 AM
I work for a dermatology practice, who bills 17106 quite often, usually for hemangiomas that are enlarging.I have an awful time getting insurance to pay for this, without a fight. Does anyone else have this problem, or any suggestions to get it paid.
Thanks
Title: Re: CPT 17106
Post by: oneround on July 14, 2010, 12:09:47 PM
This code is used to report treated ares of less then 10sq cm, 17107 for 10 sq cm to 50 and 17108 for more then 50..

What is the denial you are getting?  And is this code being billed with any other code?
Title: Re: CPT 17106
Post by: JSANDERS32 on July 14, 2010, 12:38:36 PM
Not being billed w/ any other codes..Usually, it is denied as either cosmetic, or not a covered benefit under patients plan. I almost always end up sending the notes and explaining that it is not cosmetic. Just wish it would be paid the first time.
Title: Re: CPT 17106
Post by: oneround on July 14, 2010, 12:48:41 PM
most all carriers are going to first see this as a cosmetic procedure as doctors tend to agree/disagree on the medical necessity.

Doctors disagree over how hemangiomas should be dealt with. The answer may depend on whether you see a dermatologist, plastic surgeon, pediatrician, or other specialist. Because many of the smaller birthmarks resolve on their own with no intervention, most doctors agree that you should leave small hemangiomas that are not growing alone, especially if they are on skin normally covered by clothing.

The medical necessity argument are some as discribed below.


Hemangiomas that require early aggressive treatment include those that are cosmetically deforming, growing rapidly or obstructing vision, hearing, breathing, eating or any other body function. Hemangiomas on the lower face and neck may later block internal airways. Large facial hemangiomas may cause psychosocial impairment. Also, larger hemangiomas that are left alone to regress (shrink away over years) will eventually look better if the resulting saggy, stretched out skin and fatty tissue is surgically removed.

Because I am more experienced on the coding side then billing my suggestion would be to submit the chart notes along with the initial submission of your bill in hopes that it wont get denied as ''non covered' the first tiem..  Hopefully some of the billing experts on this form can adivse on the billing techniques.
Title: Re: CPT 17106
Post by: JSANDERS32 on July 14, 2010, 12:58:45 PM
Thanks so much for taking the time to respond.