States Applicable to Alert: Northern and Southern California
Background Information: Procedure codes in the Treatment of Ulcers and Symptomatic Hyperkeratoses Local Coverage Determination (LCD) contained incorrect diagnosis for coverage. Therefore, the services were denied incorrectly.
- Policy L28308 (Effective September 2, 2008)
Applies To Procedure Code(s): (if applicable)
11040, 11041, 11042, 11043 and 11044
Modifier(s): (if applicable)
N/A
Remark /Reason Codes: (if applicable)
50 and N115
MAC Action: Diagnoses for this LCD were corrected in the system and a mass adjustment was completed on December 15, 2008. There were 8046 claims adjusted for Southern California and 5987 claims adjusted for Northern California. For claims with multiple surgeries, 656 claims for Southern California and 168 claims for Northern California were forwarded for reopenings in order to pay the claims correctly. The reopenings/reprocessings were completed by February 28, 2009.
Provider Action: No Action Required
Date Reported: October 20, 2008
Date Resolved: February 28, 2009