Billing OV with modifier 25 with joint injection

ahousner

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Dearborn, Michigan
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Hello, I bill for an orthopedic practice. Our doc's are billing joint injections with an office and using mod 25. The insurance companies are rejecting the ov.
What is the best way to appeal the denial?
Our documentation supports the ov.
 
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Hello, I bill for an orthopedic practice. Our doc's are billing joint injections with an office and using mod 25. The insurance companies are rejecting the ov.
What is the best way to appeal the denial?
Our documentation supports the ov.
I’m a biller in an ortho office as well. I’m getting the same types of denials. The ov’s that are getting denied are because the patient had an injection into the same body part for the same reason as a previous ov. If that’s the case with your denials, I’m not sure there is anything you can do to fight it, unless the patient presented with a new problem.
 

sarab86

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Fort Myers, FL
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Was the injection planned ahead for that day or was it discussed and decided in the room at the time of service? That would be the difference. If it was planned ahead you cant really argue the insurance to pay for the OV. If the Inj was discussed and decided at the time of service than you can argue for payment.
 

SharonCollachi

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Clovis, CA
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If this is for a BC patient, as of 10/1/20 the issued this reimbursement update for joint injections and ear lavage being not separately reportable with an office visit regardless of modifier usage.

I'm not seeing on that document where it says that (it says not payable with ultrasound or anesthetic-lidocaine); where does it say office visit? I asked because I remember them sending out a notice that they were not paying injections with office visits which caused us to stop doing injections with office visits... if the doctor is going to spend 30-45 minutes on a pain management visit and not get paid for it because he then decided the patient needed an injection - well, nope, not gonna happen in our office.

I've been looking for that notice ever since they sent it out, and cannot find it.
 
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