HCPC 11042- Debridement, SQ tissue 20 sq. centimeters or less
Top denial/partial denial reasons and high-level results are listed below from each round of JH TPE reviews that have been conducted thus far by us. If you have questions about your individual results, please contact the nurse reviewer assigned to your review for additional information. Additional rounds of review will be utilized when the targeted topic demonstrates a continued need for review with newly identified providers.
The most common reasons for denial or partial denials are the following:
1. Medical necessity - The documentation submitted does not support medical necessity as listed in coverage requirements.
2. Insufficient documentation – Insufficient documentation was provided to support the services as billed to Medicare. Novitas Medical Review makes multiple attempts to correct these error types before completion of the review. Below are the following denial reasons for insufficient documentation that we were not able to resolve:
Missing Physician documentation of information essential in establishing that the patient meets the coverage indicators as set forth in the LCD.
The documentation submitted for review did not include the physician progress notes of the wound response to treatment.
The documentation submitted for review did not include a complete physician procedure note for the surgical debridement code billed.
Round results (5H1W1)
Round results (5H2W1)
Round results (5H3W1)