1. J

    Question Do in office procedures count toward MDM column 3?

    If a physician decides to give and bill for an injection during an office visit does this count toward the MDM (column 3)? Patient presented with plantar fasciitis which is progressing in pain over the past several months. The provider then performed below injection: "At this time, the foot...
  2. M

    Question SI Joint Injection dx code M46.1 vs M53.3

    I sent the following email to my providers and received one positive response and one negative response and one non response. Reaching out to get your thoughts on it. "Good afternoon, I wanted to go over these diagnoses with you. M53.3 Sacrococcygeal disorders, not elsewhere classified M46.1...
  3. KStaten

    Injection Template Documentation Guidelines

    It has been to my understanding that the provider is responsible for documenting the procedure, exam, and plan (unless he/she is assisted by a scribe). IF a provider decides to start using a template (such as for routine joint injections), which has drop-down menus to enter the correct...
  4. D

    Can you pick and choose what you bill?

    Hey, Is a physician required to bill for the services that he or she performs? Example: Established patient receives an injection ( 20550 ), an ultrasound (76882). Is it possible to not bill the carrier the 20550 and do a 99213 instead since you cannot bill a OV on the same day you bill a...
  5. C

    Question Medicare denying claim for missing procedure modifier

    Last Update: My supervisor says she doesn't want me doing denials. At least, not yet. It was a co-worker who had asked for my help in getting it done. I had wanted to try doing denials anyway, but since I was dropped into the deep end without a float, I felt frustrated and stuck when the...
  6. A

    Question Documentation for Arthrocentesis and Injections

    I am trying to find a break down of the required elements of documenting arthrocentesis/injection. Clarification on what I am looking for to ensure the injection is documented correctly. Something I can use to show providers what is missing. I have the gist, but having a detailed break down...
  7. C

    greater and lesser occipital block CPT

    Hello, I am trying to correctly code for Px greater AND lesser occipital nerve blocks bilateral. Would the correct coding be 64405 AND 64450? Or would one be inclusive to the other? Please advise, thank you!
  8. KStaten

    Repeat Injections with E/M Codes

    Greetings Fellow Coders! :) Scenario: A new patient is evaluated and found to have OA of the left knee. On that visit, the physician decides to perform an injection and bills an E/M (99203) with a modifier 25. At that visit, the physician does not "plan" another injection. If the patient...
  9. K

    Question Ingestion Challenge... via Injection?

    Hey Coders! Our allergy office gave an injection to test for an allergy to an antibiotic. They followed the same process as an ingestion challenge, but the medication was administered via an injection, not orally. I am thinking we would bill an E&M for the time we spent with the patient...
  10. M

    Question Injection given in patient's home

    The office I work for (outpatient behavioral health) is planning to start having nurses go to patient's homes to administer psychiatric medication injections. Is this billable as "incident to" since the provider is not in the building where the patient is having the injection done? If not, is...
  11. C

    Abortion Question w/injection

    I have 2 patients with similar issues. Both PTs were 24+/- weeks pregnancy, they each had an injection to induce fetal demise, both were outpatient and the actual abortion took place a day or so later. In each case the provider billed 59850 (an inpatient only code) with 76998 for the...
  12. A

    Question Laryngeal cleft repair with injection

    The doctor performed a laryngeal cleft repair with prolaryn plus. I originally was thinking cpt code 31571 or 31574. But those codes mention injection in the vocal cords and I can't find another code that is maybe closer. Does anyone have an idea if those codes are appropriate or if there is a...
  13. S

    sacroiliac joint injections

    I have a primary care provider that does sacroiliac joint injections in the office - or at least that is how he is documenting it. It's tough to imagine he is getting it into the joint without imaging guidance -- which is why CPT guidelines state that without imaging guidance to use 20552...
  14. A

    Question 64611 and 76942

    The doctor did an ultrasound guided botox injection of the submandibular and parotid gland. I'm getting conflicting information as to whether or not I can code 64611 and 76942 together. Do I just code 64611 for the injection or do I also code 76942 for the ultrasound guidance? Thanks!
  15. M

    Injection for Ocular pain

    I coded 67515-LT with Diagnosis code H57.12 and it was denied for not matching. What CPT code should I be using instead? This is just an injection for ocular pain.
  16. P

    Question Urology coding question

    Medicare is denying payment for coaptite injection using 51715. It seems that they do not like any of the incontinence diagnosis codes but that is all the doctor describes as far as diagnosis. Does anyone else have this problem? Or is there any other diagnosis code I could possibly use?
  17. W

    Doxycycline Injection into Festoons

    Hi, I have a doctor wanting to inject Doxycycline into festoons for treatment of lower lid retraction. I am thinking 11900-intralesional injection is the correct code, but I want to get some second opinions. Thanks!!
  18. S

    Injection for cash & carry items

    I was hoping you could give me any directions or point to any policies to provide for our physicians. We have a physicians that would like to start offering Lipogem injections to patients. Since these are not a covered item for insurances we would be offering this as a cash & carry item. If...
  19. M

    SI Joint Injections

    We are having a discussion in my office about the correct coding for a non-image guidance in office SI joint injection. 1 coder says 20610 and the other says 20552. What is the correct CPT code?
  20. K

    Psychiatric Injection CPT codes

    Are there any CPT codes that can be used in a psychiatric outpatient office setting for injections? (Invega Sustenna, Suboxone, etc) Should HCPCS codes be included with this also? Also, if a nurse is performing the injection is 99211 used alone? Would insurances reimburse for an E/M with...
  21. C

    20610 (multiple units and location) and Depo medrol and labs (89051/89060)

    Hi all, I've asked the questions in a few different places on here and thought it would be better if all together to show the true picture. I've read all of the AAPC articles on the subject of 20610, so I'm familiar with when in diff joint etc, but there's some confusion on joint and bursa in...
  22. I

    Pre Op Injection Administration

    I am an auditor and have a hospital who wants to charge administration for Pre-Op IVP Versed (96374). I have explained that this would be considered part of the facility's Global Surgical Package as anesthesia writes for the medication when they begin to prep their patient for the operating...
  23. C

    Can I bill 96732 3 times for the same injection for the same exact drug/dosage.

    Hello: Nucala (J2182) has a new indication that requires 3 injections (96372/96401) at the same time in slightly different areas (arm, butt, thigh - any or all). All 3 injections are exactly the same (I have been billing for a singular injection for their original indication). I can bill the...
  24. C

    Federal BCBS rejecting 62323 and 62321

    We have been having issues all of 2017 with FEP denying 62323 and 62321. First for medical records, and then when we send them, that our providers are not eligble to perform the service. 62311 and 62310 we never had any issues with nor are we having any issues with any of our other injection...
  25. candyjl78

    Botox Injections and Waste (Remaining given to another provider)

    I have a scenario where one provider gives the patient a Botox injection for a migraine and they want to give the remaining Botox to another physician in another clinic (but through the same hospital) to use for neuropathic pain on the same patient. The patient's insurance will pay for Botox...
  26. A

    76000 vs 77002

    I work in a plastic/reconstructive surgeons office and we do a lot of hand/wrist work including injections. Something I am seeing a lot of is the use of 77002 and 76000. My understanding of the descriptions of each is that 76000 is to be used for more extensive imagining i.e. confirmation of...
  27. B

    90471, 90649 vs 96372

    When a patient requests a Gardasil immunization, the patient picks it up directly from the pharmacy. The patient picks up ONE dose of the vaccines, brings it to our office, and our MD injects the patient. Some in our office are billing 96372 w/ Z23. I recently billed out the 90471 alone and it...
  28. L

    Lipoma Block

    We have a newer procedure that our nurse described as a "left lipoma block, injected in the erector spinae at the lumbar region." We have been doing a lot of research and the closest thing we are coming up with is an intramuscular injection. Does anyone know if this is correct or if there is a...
  29. daedolos

    Injection Codes

    Recently, I had to code for an established visit and the patient requested pain management. They were seen for right shoulder pain and right knee pain and received injections for both areas. 99213-25 20610 -RT (right shoulder - subacromial) 20610 -XU-RT (right shoulder - glenohumeral)...
  30. I

    94060 or 94640 includes 96372?

    Trish CPC-A:confused: I am new to coding and bill for BCBS. I keep running across this issue and I am at a total loss. I kept getting denials for 94060 w 96372 (inclusive) and 94640 w a 96372 (inclusive). We are billing for the drug also, but why the 96372 when it is not given as an...
  31. daedolos

    Pain management during global period for shoulder arthroscopy

    Can I code for an injection to a shoulder site non specific to a shoulder arthroscopy during the global period? Is there any way to unbundle this? Please advise. Peace ?_?
  32. J

    Keloid Excision and Injection with Kenalog

    The NCCI policy manual says, "It is a misuse of CPT codes 11900, 11901, 96405, or 96406 to report injection of local anesthetic prior to another procedure on the lesion(s). Some of the procedures with which CPT codes 11900, 11901, 96405, and 96406 are not separately reportable if the...
  33. B

    ED injection and infusion codes

    Hi I am looking for a nice article or free resource that explains ED infusion and injection codes. Does anyone have a good resource? I seem to remember a HealthCare Business Monthly article, but I can't find it Thank you! Becky
  34. L

    AmnioFix injection into stricture

    what CPT code would you use for AmnioFix Injection into urethral stricture? would you use 52283? even though it's not technically a steroid? Or should I just use 52281 for the balloon dilation? Obviously I can't use both. PROCEDURE: In the dorsal lithotomy position under general...
  35. C

    54235 vs 54200

    I have a physician that is injecting lidocaine into the patient before he performs a 54200. He is wanting to bill 54235 as well. He states "I am not simply doing a subQ lidocaine injection for a local anesthetic – this is a much deeper and more involved injection that does involve the corpora...
  36. J

    Sesamoiditis injection

    I have a provider who gave a patient an injection for sesamoiditis. 20552 is coming back denied for medical necessity. Any ideas about what the appropriate code should be? I thought about 20600 or 20551.
  37. K

    Injection and Office Visit Billed together

    I have a claim where CPT 99213 was billed with modifier 24 along with a code for an injection. The medical record was submitted showing that the patient came into the office for a penile injection and the physician spent time teaching the patient how to self inject. I know that in order for an...
  38. L

    Xiaflex injections

    Hi there ! hoping for some advice here..... I have a physician who performed Xiaflex injections on a patient into the pretendinous cord to the ring finger, the pretendinous cord to the small finger and lateral cord to the small finger. When billing I am not sure how to bill for both the...
  39. K

    Medicare CCI Edits

    HI! I am having trouble getting pass the Medicare CCI edits for CPT 20611. My doctor did a corticosteroid injection to help treat Piriformis Syndrome. The CCI edit that I am running into is as follows: [Medicare] Per Medicare's Local Coverage Determination (LCD) policies, procedure code 20611...
  40. T

    Injection help - what modifiers

    help with modifers for multi injections I have a patient that had multi injection on the same day. I need help with what modifiers I would use. 20550-Lt (HAND) 20600-FA (LT THUMB) 20605-LT (LT WRIST) So do I coded 20550-Lt, 20600-FA,51 , 20605-LT,51? When I tried to bill it said I that...
  41. L

    E/M with injection same day

    I work for an orthopedic practice where the physicians see patients and do injections same day all the time. I have been trained to bill the E/M level for the visit and the injection code and append modifier 25 to the E/M level. Recently I went to an E/M workshop and the instructor told me...
  42. D

    96372 with purchased medication

    Has anyone had success billing 96372 (Therapeutic, prophylactic, or diagnostic injection) and the injection with a zero charge to Medicare? Are you getting paid or am I missing something in the process? Any and all advice is welcome!!!:) Example: 96371 x 1 $27.00 J1630 x 1 $0.00
  43. B

    J1071 - Patient Provided

    I work in an internal medicine private practice. Our patients come in with their own prescription for testosterone and will inject it for them. I know to bill J1071, however, I receive an automatic response of "Advice: Additional Procedure Code or Information Required [5077]." Should I still...
  44. S

    Stelara 45 mg/0.5 ml injection

    How do I code for this? I already know the administration code. When I look in the HCPCS book under Stelara, it gives me the generic name and then 1 mg. The provider is billing this as 45 mg/5 ml, 45 units. This Stelara is a pre-filled syringe so there is confusion at our office. Some think...
  45. B

    Orthopedic operative report

    new to Ortho Surgery. Need help coding hte following 1-caudal epidural steroid injection 2-lumbar sine epidurogram 3- facet joint arthrogram right L4-L5 and L5-S1 4- facet joint injection right L4-L5 and L5-S1 5-injection for Myelogram dye for interpretation 6-needle localization under...
  46. B

    orthopedic surgery

    I have a new client who still thinks we can use pre 2015 cpt codes. I have explained that a lot of the codes have been bundled and he wants to unbundle them anyway. Could you help in coding the procedures below? 1-caudal epidural steroid injection 2-lumbar sine epidurogram 3-left sacroiliac...
  47. S

    lavage of calcific tendinosis - shoulder

    One of my doctors performed a ultrasound guided lavage of calcific tendinosis on the left supraspinatus tendon followed by a subacromial/subdeltoid bursa injection. I am having trouble coming up with a good CPT for the calcific lavage on the shoulder. Do I default to 20611 for the shoulder bursa...
  48. A

    Trigger Point at Bedside

    Patient was supposed to go to surgery for a lipoma removal and a shoulder trigger point injection. The patient never made it to surgery and while in holding they did the trigger point injection. I know we cannot charge OR charges but can we still charge for the injection?
  49. L

    Modifier XS

    Should we be using modifier XS when an outpatient is receiving--for example--and IVP and also IM/SQ injection(s)? Should it be used on the injection(s) and each injection on a separate line?
  50. R

    Sacroiliac joint injection WITH ULTRASOUND GUIDANCE

    How would you post a sacroiliac joint injection WITH ULTRASOUND GUIDANCE. This was a joint injection using ultrasound guidance, and is documented. Our physician does ultrasound guided injections in an office setting. Comments would be greatly appreciated.