Medicare CCI Edits

KBeaulieu

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HI! I am having trouble getting pass the Medicare CCI edits for CPT 20611. My doctor did a corticosteroid injection to help treat Piriformis Syndrome. The CCI edit that I am running into is as follows:

[Medicare] Per Medicare's Local Coverage Determination (LCD) policies, procedure code 20611 is not considered to be medically necessary when supported by the diagnosis code G5701. Please review the medical record and procedure and diagnosis coding on the Claim Edit screen.

I cannot locate a diagnosis that will remove the CCI from my claim so it will drop. Below are a list of ICD-10 codes I have tried and have been unsuccessful with:

1. M4806 SPINAL STENOSIS, LUMBAR REGION
2. G5701 LESION OF SCIATIC NERVE, RIGHT LOWER LIMB
3. M5417 RADICULOPATHY, LUMBOSACRAL REGION

Please let me know if you have had this issue or have any advice for me.

Thanks!
 

CodingKing

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I'm curious what J code was used. All I can find on this code is related to Hyaluronan or derivative which require an osteoarthritis dx
 

KBeaulieu

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Yes the reason for the injection is pain. I tried the lower back pain icd-10 and that didn't work either.

The patient does have arthritis of the lumbar.

The J codes used were:

J1030 METHYLPREDNISOLONE
J1100 DEXAMETHASONE

Thanks!
 

mitchellde

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Without documentation of acute or chronic pain you cannot use a G89 code for the pain. This the code many payer want first listed for pain management interventions. Nook in your guidelines for pain encounters. Otherwise if back pain is what is documented then that is the code you need to go with.
 

mitchellde

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Without documentation of acute or chronic pain you cannot use a G89 code for the pain. This the code many payer want first listed for pain management interventions. Look in your guidelines for pain management encounters. Otherwise if back pain is what is documented then that is the code you need to go with.
 

Walker22

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HI! I am having trouble getting pass the Medicare CCI edits for CPT 20611. My doctor did a corticosteroid injection to help treat Piriformis Syndrome. The CCI edit that I am running into is as follows:

[Medicare] Per Medicare's Local Coverage Determination (LCD) policies, procedure code 20611 is not considered to be medically necessary when supported by the diagnosis code G5701. Please review the medical record and procedure and diagnosis coding on the Claim Edit screen.

I cannot locate a diagnosis that will remove the CCI from my claim so it will drop. Below are a list of ICD-10 codes I have tried and have been unsuccessful with:

1. M4806 SPINAL STENOSIS, LUMBAR REGION
2. G5701 LESION OF SCIATIC NERVE, RIGHT LOWER LIMB
3. M5417 RADICULOPATHY, LUMBOSACRAL REGION

Please let me know if you have had this issue or have any advice for me.

Thanks!

The piriformis is a muscle, and you are using a joint injection code. Perhaps that is the problem. The proper code for a piriformis injection is 20552. See http://thepainsource.com/piriformis-muscle-injection-fluoroscopy/
 

CodingKing

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