Wiki injections

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Chill74

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I recently obtained my CPC. I am billing for an Orthopedic Surgeon. I am getting a lot of denials on office injections. It seems like no one wants to pay. Any advice, direction or resources would be greatly appreciated. 20610 and J0702 are most common combination. However he does bill 20550 from time to time.
 
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Chill74 said:
I recently obtained my CPC. I am billing for an Orthopedic Surgeon. I am getting a lot of denials on office injections. It seems like no one wants to pay. Any advice, direction or resources would be greatly appreciated. 20610 and J0702 are most common combination. However he does bill 20550 from time to time.
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What specific types of denials are you receiving? There should be specific denial codes given - ex. preauthorization, frequency limits, modifier issues, etc.
 
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Amerigroup-I have about 5 more just like this
I am currently going through the individual insurance lists to see what their reason for denial is.
 

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Chill74 said:
Amerigroup-I have about 5 more just like this
I am currently going through the individual insurance lists to see what their reason for denial is.
Click to expand...

In the example that you gave, the denial is for your diagnosis coding. It says that the diagnosis coding is invalid or doesn't meet the required level of specificity.

What is the main reason for the knee injection? I'm not an ortho coder, but I'm questioning why the M17.11 osteoarthritis diagnosis isn't in the primary position.

(Most of the clinical policies I'm looking up for knee injections seem to have specific lists of diagnosis codes that meet medical necessity. Osteoarthritis seems to be on most of the lists, but I haven't seen any that say M66.0 meets medical necessity. Again, I just did a quick skim of readily available clinical policies and LCDs, and I'm NOT an ortho coder.)

Also, I would drop the M25.561. It's redundant - "pain in right knee" doesn't need to be captured separately when you already have the osteoarthritis code on the claim.

There's an ortho coder who comments on the board regularly - they could probably provide better and more insight than me. Hoping I can attract their attention to this post to chime in. @Orthocoderpgu
 
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