Wiki Coding help with trigger points

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jmjam2005

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Hello my fellow members. Question for you....im wondering how you would code this? Trying to get some feed back on a few things to iron some things out-TY in advance!>>>>
Patient presents with pain and spasms in the bilateral cervical regions, with associated tenderness radiating to the lower cervical region. Patient also complains of pain and spasms in the lower lumbar regions, with associated tenderness radiating to the lower extremities.
Procedure was explained to the patient. The patient relayed understanding of the risks and benefits involved. 6 mL of 40 mg/1 mL of Kenalog mixed with 6 mL of 2% Lidocaine 20 mg/mL mixed and injected in the following muscles:
2 mL right and left supraspinatous muscle
2 mL right and left trapezius muscle
2 mL right and left cervical paraspinal muscles
2 mL right and left glutei muscles
2 mL right and left lumbar paraspinal muscles
2 mL right and left sacral paraspinal muscles
Patient tolerated the procedure well. No immediate complications seen. Patient is recommended to continue with previously recommended managment.
This is what is given mind you I didnt code this:
20553
J3301 24 units
96372
Along with the OV code and some labs.
 
You will not use the 96372 code as no IM injections are listed. I am not sure where the 24 units is coming in as I get a differen number. You cannot bill for the lidocain at all only the kenalog. I do not see a separately billable E&M code in what you have submitted.
 
20553 is correct for 12 muscles
20553 includes the actual process of injecting so I have no idea what the 96372 was for.
Drug dosage I'm not very skilled at but 24 units sounds right 240MG (6 vials of 40MG each?)
If the OV was decision for surgery or unrelated to the back pain its allowed to be separately reported w/ modifier
 
Thats what I thought. I recently took this account over and I am seeing so many things incorrect of which this being one of those scenario's. Wouldnt the J3301 just be billed out at 3 units? then the 20553 without the 96372. I appreciate your input. And happy holidays

Jennifer M. Malmsten
 
The problem I have with the math is each injection is 2ml not 1 so each injection is 80mg of Kenalog. But then they dilute it with the lidocaine so it is not 80 mg for each one. The total amount mixed is 6ml. See what I mean the math is not working for me. I would like to see how the poster arrived at the 24.
 
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Trying to learn here so if my math is off let me know

a total of 12ml was injected (1ml into LT and 1ml into RT x 6) 6mL Kenalog, 6mL Lidocaine

Disregard the Lidocaine since its not separately billable

That leaves 6mL of Kenalog. If its 40MG of Kenalog per mL wouldn't it be 6*40MG = 240MG

J3301 is 10MG per Unit

*EDIT*

Looks like its not the amount injected that we are disputing but Units per MG?

I'm using findacode and its listing

J3301 - Injection, triamcinolone acetonide, not otherwise specified, 10 mg
 
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One unit is 40mg in a 1 ml vial. Each vial opened is one unit. If you mix 6ml of Kenalog with the lidocaine you have to open 6 vials. So 6 units. Now if they were using the 10mg/ml Kenalog then they would have used more than 6 ml to obtain the same concentration. And then it would be 24 units. But they used the higher concentration of 40mg/ml. Kenalog comes as either 10mg/ml or 40mg/ml with the same J code.
 
the notes state 40mg so id say to bill out the 6 units then. This is just one of the many of her billings I dont understand. Again I appreciate all the feed back
 
I looked up the HCPCS code and the Medicare website stated to use the same code for each different concentration. This is where my logic came from, I am not saying it is correct only that mathematically it works. I am always open to other logic, but given what Medicare stated this is what I come up with.
 
Need Help with getting Kenalog paid

Can someone tell me how they are getting all of the units paid for the Kenalog shots? When we bill out 4 units the insurance companies are only reimbursing us for 1 unit, we then have to appeal and fight every claim, is there a way to get around this.
 
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