May 17, 2018
I performed a soft tissue tumor of the neck 5cm with an intermediate repair on a Medicare patient. I coded 21552 and 12042 for the repair. The claim for the repair was denied. I am not certain why the repair was not paid. I performed the procedure. Can I file an appeal?
No, you cannot report the intermediate repair not matter who the payor is. The soft tissue tumor code 21552 includes either a simple or intermediate repair. Only a complex repair or more extensive close such as an adjacent tissue transfer, flap or graft can be reported in addition to the excision.
*This response is based on the best information available as of 05/17/18.