Wiki Coding and dx help

ddcool

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Hi,

Need help with the following if possible. How would you line up these dx's to procedures?
99203
20553
j1030
76942
dx's are M54.2, M25.519, M62.838 and M79.1

I just go this new client and they are kinda rushing me ( grrr) and although I have been billing for years for specialists this area is new.


Thanks for your time.
 
99203 - New patient, detailed hx and exam, mdm low
20553 - Trigger point injections, 1-2 muscle groups
76942 - Ultrasound guidance for needle placement
J1030 - Depomedrol

M54.2 - Cervicalgia (neck pain)
M25.519 - Pain in unspecified shoulder <--- there's no reason why they couldn't code which shoulder
M62.838 - Other muscle spasms
M79.1 - Myaglia <--- now a non-billable code. The new choices are M79.10, Myalgia of unspecified site; M79.11, Myalgia of mastication muscle; M79.12, Myalgia of auxiliary muscles of head and neck; and M79.18, Myalgia of other site. Since they have not given you more info, it would be M79.10.

Of these dx, Medicare (and anyone who follows Medicare rules) will only pay for M54.2 as a primary dx for trigger points. If they had used M79.18, that could also be a primary dx for trigger points.

If they are using ultrasound guidance routinely for trigger point injections, they are either inexperienced or just trying to pad the bill. The majority of trigger points can be accurately injected by touch alone - it's a hard knot under the skin, it's not like you're going into a joint. Just my two pence on the subject.

If your insurance requires a modifier any time you bill an E&M and a procedure, you'll need a 25 on the 99203, if the patient did not come in just for trigger point injections.

99203-25, any dx order
20553, M54.2, then any order
76942, M54.2, then any order
J1030, M54.2, then any order
 
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