Injection Denial

Best answers
I'm wondering if anyone can help me or give me some thoughts. I have a patient that had pes bursitis, lateral deltoid insertion tendinitis and biceps tendinitis. All on the right side. This was done in 2015 so it's ICD9. For the injections, i put 20610 RT (726.61), 20550 59 RT (726.12), and 20551 59 RT (726.19). The note specifically says that the deltoid insertion was injected which is why I used 20551 and the biceps tendon I use 20550. I wrote an appeal and sent the documentation. In the appeal I stated that they were three completely different areas/injections and that we should get payment. This 2nd level appeal I'm writing brings up the fact that the LCD list even supports the DX codes & CPT codes. It also brings up the guidelines stating that if they were into the same tendon sheath/ origin then I would only charge for one injection. These are two different ones (as if the names of both weren't enough). I just don't know if i'm missing something or what. Payer is UHC.

Thank you!


True Blue
Salt Lake City, UT
Best answers
The problem is not you, it's UHC. We had a patient fall through the floor of a building and was impaled in the stomach by all the debris. The patient had to be flown to our hospital which has a Level 1 trauma center to have emergency surgery to save his life. UHC denied this claim as not meeting the definition of an "Emergency".

I think your wasting your time with a 2nd level appeal. I have had more luck by getting their patients to call them though that won't be helpful in this circumstance.