Wiki Billing ultrasound guidance with another procedure

[LHelmers]

Dr. saw a patient and performed a left hip injection without ultrasound and a right volar wrist injection with ultrasound. AARP UHC MCR Adv is denying the ultrasound portion of the claim saying it is inclusive: “This procedure is not paid separately.”
We appealed with medical records, and they upheld their decision. Please help. What are we doing wrong?

99204-25 DX M19.041, M19.042, M25.511, M25.512
20610-LT DX M70.62 - left hip injection
20526 DX G56.01 - carpal tunnel injection
76942 DX G5601 - ultrasound guidance on the carpal tunnel injection for the wrist - (This is the denied CPT)
J1010 DX G56.01, M70.62

 

[ambernic]

Dr. saw a patient and performed a left hip injection without ultrasound and a right volar wrist injection with ultrasound. AARP UHC MCR Adv is denying the ultrasound portion of the claim saying it is inclusive: “This procedure is not paid separately.”
We appealed with medical records, and they upheld their decision. Please help. What are we doing wrong?

99204-25 DX M19.041, M19.042, M25.511, M25.512
20610-LT DX M70.62 - left hip injection
20526 DX G56.01 - carpal tunnel injection
76942 DX G5601 - ultrasound guidance on the carpal tunnel injection for the wrist - (This is the denied CPT)
J1010 DX G56.01, M70.62

From what I can see, you coded this correctly. If the documentation clearly documents the ultrasound was used for the carpal tunnel injection, maybe you should make a phone call and see if you can talk with someone regarding it. I'm assuming they see it being billed with the hip injection and are denying based on the fact that ultrasound guidance cannot be billed with 20610.