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Joint Injection with Fluoroscopy and Ultrasound

M

Melissa Harris CPC

Expert
Messages
285
Location
Scotia, NY
We have a new provider who utilizes Ultrasound for procedures (we have only used fluoro in the past). She is using both Fluoro and Ultrasound during a joint injection. Can we bill for both? Both are documented in the procedure note.
 
Without procedure codes to check and see if there are any NCCI edits for billing the fluoro and ultrasound can be billed together, my thought is that these both are likely able to be billed on the same DOS.

However, I work for an insurance company and at some point, we would likely question the medical necessity of performing these joint injections with both fluoro and ultrasound when it isn't the standard practice.

What is the medical necessity of your provider using both of these imaging modalities when performing joint injections? This sounds ripe for an audit from an insurance carrier perspective if your provider is routinely billing for both these services with the joint injections.
 
Are you sure both are definitely being used and there is not possibly a documentation or dictation error? Especially if the provider is new and maybe the EHR is new to them or macros are still being set up? I can't see how both would ever be used at the same time for a joint injection. I guess it could be done but it doesn't make sense.
If it's a joint injection with US it's 20604, 20606, or 20611.
There's an edit if you were to try and report any of these above codes with 77002.
 
CBLENNIE said:
Without procedure codes to check and see if there are any NCCI edits for billing the fluoro and ultrasound can be billed together, my thought is that these both are likely able to be billed on the same DOS.

However, I work for an insurance company and at some point, we would likely question the medical necessity of performing these joint injections with both fluoro and ultrasound when it isn't the standard practice.

What is the medical necessity of your provider using both of these imaging modalities when performing joint injections? This sounds ripe for an audit from an insurance carrier perspective if your provider is routinely billing for both these services with the joint injections.
Click to expand...
Agree 100% with the audit target.
 
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