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Claims edit to go into effect July 30, 2019


The following claims edit will go into effect July 30, 2019:

Policy: Pilonidal cyst and pilonidal sinus procedures

Policy description: Incision and drainage of a pilonidal cyst (10080-10081) and excision of a pilonidal cyst or sinus (11770-11772) should only be reported with a diagnosis of pilonidal cyst or pilonidal sinus (ICD-10 codes L05-L05.92). These procedures will be denied when reported without an appropriate diagnosis.

Reference: AMA CPT Manual

Plans affected: ConnectiCare commercial and Medicare Advantage plans