Injection Denial

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144
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Hello,
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!
 

Orthocoderpgu

True Blue
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1,603
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Salt Lake City, UT
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9
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.
 
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