Wiki 20610 billed 3 times to medicare

[boyett]

hello everyone,

I have a question about joint injections for medicare. we have been having some issues and cant seem to locate any document to clear them up.

we have billed a left and right knee injection and a right shoulder injection as follows

20610 lt
20610 51,rt
20610 51,rt
j7324 x3 units

the medications were paid however the administration codes were not . how would you bill this? we spoke to medicare and they state you can only bill 2 units max on this code. I don't believe this is correct due to there being 3 different sites.
we are also having an issue with medicare only paying on one side of a joint injection and denying the other as a duplicate if we bill them left and right. they reimburse lower if we bill with the modifier 50. how can these also be billed ?

all information is appreciated and thank you in advance for your help

 

[Orthocoderpgu]

I'm not sure who you MAC is, but ours says to use -59 once, and -XS for the others. This may be what their computers are looking for. The way you have it coded now, no -59 modifiers, they are going to bundle the procedures regardless of the -LT and -RT modifiers. As far as saying you can only bill twice, that is not true. There is an MUE of two this year, but CMS.GOV also states that you can get the procedures paid above the MEU amount with documentation. Use -59 once, -XS for the others. You will have to appeal the denial with medical records for the MUE.