Wiki Injections

leastham

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We got a eob back from medicare denying a claim for a office visit after giving a 2nd 20610 injection in the knee. Patient had her first one in April and then she had another one in June. We used modifier 25 but they denied it saying it in in the post op period. What can I use to get this to go thru medicare. Different code or modifier?

thanks
 
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We got a eob back from medicare denying a claim for a office visit after giving a 2nd 20610 injection in the knee. Patient had her first one in April and then she had another one in June. We used modifier 25 but they denied it saying it in in the post op period. What can I use to get this to go thru medicare. Different code or modifier?

thanks

20610 has no global days. Did the patient have a surgical procedure (menisectomy, chondroplasty) in the past 90 days? I would start there.
 
You may want to look at whether the E/M is really billable. If the patient came in for the purpose of receiving the injection and wasn't evaluated for a different issue, the E/M isn't billable, it's inclusive to the injection. We've gotten denials like the one you described and that ended up being the issue.
 
Ahhh, I agree with KDaniel, you mentioned "the 2nd was given", could this be for Synvisc or a planned series? If so you can only bill for the initial O/V and then the follow up injections and not follow up E/M because the series of injections was already planned at the inital O/V.
 
You cannot bill an E&M with a 25 modifier when the procedure is planned as in a planned second injection. You bill the inject and the J code only.
 
We got a eob back from medicare denying a claim for a office visit after giving a 2nd 20610 injection in the knee. Patient had her first one in April and then she had another one in June. We used modifier 25 but they denied it saying it in in the post op period. What can I use to get this to go thru medicare. Different code or modifier?

thanks

Is the denial for 20610 or an e/m? You can only use -25 on e/m codes. And as someone else asked, did the patient have knee surgery on the knee being injected within the last 90 days?
 
injection

I agree with Kdaniels. I just recently found out that if patient is coming in to receive injection that was discussed on earlier visit you can't file an E/M and injection code unless the patient was being seen for something different. This was in a webinar offered by AAPC to prepare for COSC exam.
 
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