Wiki Cpt 20552 with 96372

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carriesaint

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This is my first time posting. I am getting a denial when we bill 20552-59,96372-59 and the "j" code(for the 96372) from Amerigroup and when we call they tell us those 2 codes are bundled. Can anyone help me with this? We are looking to appeal these because they are 2 different injections we are giving....one with (toradol, for example) and the other as the trigger point. Am I right in my thinking or am I totally off????:confused:
 
you only need the 59 on the one that would be bundled and what are your dx codes? If the injections are being given for the same problem then they may take issue with that saying the toradol was just a patient comfort measure for the tiggerpoint. But if you have two different issues then you should link your dx to the line item it goes to and only that dx. SO truely more info is needed to give you a complete analysis.
 
Yes...we only put the mod-59 on 96372. Dx codes were the same 724.2,724.4 and basically we do give the toradal to just help the pt with general pain. Are these 2 codes usual bundled with all payers? We have done this a lot and have just recently told the doc to stop until we figure out if we can get paid or not. Do you need more to analyze this scenario??? So, if the patient is getting a trigger point and then they also have sinusitis and are getting therapeutic shot for that, of course the dx codes would be different...but if the 96372 is just for the same dx as 20552 or 20550 then payers may assume they are bundled??
 
Yes and it sounds like they should be. You cannot/will not be reimbursed for a comfort measure with a therapeutic one. This is why providers cannot charge for the lidocaine as a confort measure. The trigger point injection can be given safely without the use of the toradol, so for you to give it is not reimburseable.
 
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