1. R

    Wiki Guidance on coding medications

    Hello! Recently the company I work for opened an imaging center and they are now billing for medications administered and contrast. This is something I am not super familiar with and feel as though I am struggling and cannot find much guidance on. I am wondering if there is any good webinars or...
  2. C

    Wiki 2410 Loop Rejection

    Anytime I code a J3301 - Kenalog - injection with injection CPT it kicks back in the system stating a 2410 loop This is the rejection: 06/15/2022 view less Payer Rejected J3301 H MISSING OR INVALID INFORMATION. ADDITIONAL DETAILS WILL FOLLOW IF AVAILABLE (J3301) Missing or invalid...
  3. A


    We have been having an issue of getting our pain management injections paid by Optum Lifeprint (ex. ESI, MBB, RFA, Joint, etc). Everytime we bill an injection, we get a denial stating that Optum requires a drug code to be associated with the claim. And here is the kicker: we don't buy the drugs...
  4. KStaten

    Wiki Are all 20610 Injections considered "Intra-articular"?

    Question: Are all injections that fall under the CPT code 20610 considered "intra-articular," or does that term not apply to ALL injections that can be performed under the 20610 CPT code, such as injections into the bursa? THANKS!
  5. Y

    Wiki Prescription Drug Management - Credit For Therapeutic Injections and Vaccines?

    Hello, would a therapeutic injection or vaccination/immunization count towards the Prescription Drug Management in the MDM calculator? Thanks, Y. Trahan
  6. KStaten

    Wiki Humana Denials: Why Does Humana Request Bilateral Modifier 50 for Non-Bilateral Body Parts?

    Hello Everyone. :) Does anyone else have issues with Humana denying injections for non-bilateral body parts (such as a left shoulder and right knee injected on the same visit) because they are requesting the bilateral modifier 50, rather than the correct LT/RT; XS modifiers ? Is there a way to...
  7. KStaten

    Wiki Billing 20550 (or 20551) with 20610

    Hello, Everyone! :giggle: As usual, I have a 2-part question and would appreciate your help. 1) When 20550 (or 20550) is being billed with 20610 for two separate body parts, which modifiers would be used? Example: tendon sheath injection, left elbow bursa injection, right knee 2) Also... I...
  8. K

    Wiki Durolane Injection Help

    Hi. Can someone help me out with the following injection dilemma: Durolane 60 mg/3 mL intra-articular syringe - Take 3 mL by intraarticular route. Quantity: 3 mL If the Doctor injected 3ml to the knee and the drug is 60mg/3ml then how would I put this on a claim for the units? would it...
  9. L

    Wiki Acne Visit with Injections-PA Derm Office

    Pt was seen for routine monthly acne visit. Dr notes have Acne Post Inflammatory Hyperpigmentation and Acne Scars, same note every month. This particular visit she injected one spot on pt due to its size and location-one spot of the acne. she has an office visit of 99213 and 1 injection of...
  10. L

    Wiki 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...
  11. A

    Wiki Lucentis Injections

    Hello Everyone, My administrator has asked me to verify payment of a Lucentis Injection for a patient who has a MediCal HMO. The facility has an authorization for the procedure, which includes the J2778, as well as the 67028. The IPA for the HMO is stating as long as I have the approval, it...
  12. L

    Wiki Can you bill 96372 if done by ma

    We have patients come in for injections, ie: B12, Depo... if they come in just for the injection and it is given by a MA and the patient doesn't see a provider, can we still bill for the admin 96372? The question was raised in our office that in order for us to bill a "nurse visit" the nurse...
  13. S

    Wiki Billing two injection codes 96372/90471

    Hi All, I am hoping someone can assist me with this coding scenario. I have a patient that received Vitamin B12 shot and zoster vaccine (shingles). Can we bill 96372 for the B12 and 90471 for the vaccine? Or do eat one...if so, which one should be billed in this case? Please help!
  14. Z

    Wiki Billing for 95874 and 76942

    I need help with billing for codes 95874 and 76942. Does anyone know if CMS or CAHABA, has a written guideline that states codes 95874 and 76942 cannot be billed together for the same patient on the same day when a provider is injecting 2 or more extremities on that same patient. Thank you in...
  15. L

    Wiki 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?
  16. C

    Wiki Methylprednisolone injections for tracheal stenosis during bronchoscopy

    Our provider performed a bronchoscopy which included balloon dilation of the trachea as well as injections of Methylprednisolone to the upper trachea. I have been unable to find a code for the injections during the bronchoscopy. Would this be included in the balloon dilation or is there a...
  17. P

    Wiki Informed Consent For Injections

    Does anyone know if it's required to get a signed consent by the patient, for steroid injections performed in an orthopaedic practice? Our office does a lot of Visco and cortisone injections and the doctors feel as though this is part of normal ortho care and if they get a verbal consent and...
  18. L

    Wiki PLEASE HELP with Radiofrequency denials

    I work for a pain clinic and my doctors perform radiofrequncy injections. I believe we are billing them correctly 64635x1 and 64636x2 when three nerves are injected. However we have ran into issues with an insurance that is denying the additional unit and stating we can only do two (64635x1 and...
  19. S

    Wiki 96372 Injection

    We have a patient with this request: Dilaudid as 1 injection (Site: L upper arm), Promethazine as 1 injection (Site: L hip), Toradol, dexamethasone, and Diphenhydramine as 1 mixed injection (Site: R hip) Normally, the doctor would mix all of the above medications and give 1 injection into the...
  20. J

    Wiki Trigger Point Injections specificity

    Is it necessary to list the specific names of the muscles injected, or can I bill based on the area of the muscle- for example, "Bilateral C2-3 paraspinous (1 cc x 2 injections), bilateral C6-7 paraspinous (3 cc x 2 injections), bilateral C7-T1 paraspinous (3 cc x 2 injections), bilateral T2-3...
  21. H

    Wiki Billing OVs with Medicare injections for Orthopedics

    For Orthopedics, For Visco supplementation injections which occur once a week for 5 weeks with the same diagnosis code, can an OV be billed on each visit? The physician does document a physical exam, but the diagnosis code is osteoarthritis. Thanks
  22. T

    Wiki Prolia & Lupron Injections- Questions

    I have a Medicare Advantage HMO patient coming for 6 month Lupron injection-( 24 weeks from 08-07-2015) and will also need Prolia injections ( 24 weeks from 09-11-2015) Question #1. Can both injections be done on same day? Question #2. Is it OK to give Prolia on exact 24 weeks date?
  23. M

    Wiki HELP PCP keeps doing Trigger Point Injections and feels ORTHO codes same way

    Will someone who codes ortho please help me... I'm in serious need of direction for steroid injections that are given in the office. One of the PCP continues to give injections that fall under trigger point injection rules and doesn't understand that he must document the muscle group where...
  24. L

    Wiki Ultrasound Guided Injections

    Hello, Doctor did an Ultrasound in the office to see what was going on with the shoulder Then he did an ultrasound guided injection into the tendon sheath. How would I code this? 76942 20550 - LT (Injection tendon sheath) J1030 - 40 mg Depo Medrol Or would I use 76881 with the above...
  25. D

    Wiki Injections-someone can help

    I hope someone can help. I have a patient who will be having a hip injection in a surgery center. Dr. told this patient that since he will be doing the hip, he will also just give him his first set of Euflexxa injections in the knee. If the surgery center will allow us to bring the...
  26. C

    Wiki How to code SI joint injections with ultrasound done in the office?

    My providers do SI joint injections in the office, and I know that CPT states to use 20552 which is presumed that the injections are being done into tissue and not into the actual joint. My providers are using ultrasound to visualize the actual sacroiliac joint and injecting into the joint...
  27. J

    Wiki 64479-64484 changes for 2011

    I noticed these codes were revised for 2011 to include "imaging guidance (fluoroscopy or CT) and contrast injection." Does this mean that we do not have to code the 77003 for a facility anymore? I am thinking not... but want to double check. Thanks for any help you might be able to provide.
  28. C

    Wiki CPT code for Injections When patients bring their own meds

    Hey guys! My practice has been using 96372 for b12 injections when patients bring their own meds. Recently we have been getting denials for "lacking a required modifier" when we have more than one injection. Usually they have a vaccination and also an injection of their own meds. Our office...
  29. L

    Wiki Immunizations & Injections

    Does anyone have a good procedure for coding nurse visits for immunizations and other injections? I work at an FQHC and there are several people here with different approaches to handling the documentation and coding of such visits... Thanks for any suggestions you can provide!
  30. M

    Wiki Coding multiple injections 20550 and 20600

    I wanted to know if anyone has a opinion on how to code multiple injections. So my hand surgeon is doing injections of the tendon sheath for tigger finger of the Middle finger and ring finger CPT 20550 x 1, than he does injections on the same fingers but in the PIP joint of each finger CPT 20600...
  31. B

    Wiki Need Help! IT band tendinitis and injection

    I would like to hear what code others are using for this diagnosis. I see this regularly and treatment is often an injection (20551) at the hip or knee. CMS does not have an LCD for this and my injections are denied. Any suggestions? Thanks