Wiki Payments on injectibles

[larcwing]

As I am posting payments I am noticing a trend on lidocaine and marcaine not getting paid. Is there a reason for this?

Thanks

A newbie

 

[tdml97@yahoo.com]

What kind of rejections are you getting??? What insurance???

 

[larcwing]

Medicare saying it is a part of another service, I believe blue cross/blue shield is saying it as well.

 

[tdml97@yahoo.com]

OK, give me an example of what you are billing out

 

[larcwing]

99212, 20610, j2001, j7321
or
99212, 20610, j2001, j1030

thank you for the help

 

[larcwing]

Also 99213, 20551. 20610, j0702, j2001, j1030

 

[tdml97@yahoo.com]

Are you using any modifiers???


This is how I bill out mine:

99213-25 - 4011
20550 - 72610
J1030 - 72610

Which code are they saying is inclusive?

 

[larcwing]

It is just the J2001 and J0670 when used in combination with another injectible. I have seen one case the only injectible used was lidocaine and it got paid.
Yes we always use the mod 25 on the OV code.

 

[tdml97@yahoo.com]

Have you tried a mod 59 on the injections?

 

[larcwing]

Yes. No luck. After google I am reading it is not payable if used in conjucuntion with another drug for comfort.

 

[tdml97@yahoo.com]

Well, it sounds like you tried everything - they are going to have to be w/o as inclusive. Make sure the docs know.

 

[mitchellde]

The code J2001 is for IV Lidocaine and you are giving an intra articular injection. You cannot bill this code for the lidocaine and there is no code for the lidocaine for the route you are using, it is a comfort measure and is not therapeutic for the patient's diagnosis which is why you cannot bill it.

 

[DeeCPC]

As I am posting payments I am noticing a trend on lidocaine and marcaine not getting paid. Is there a reason for this?

Thanks

A newbie

A 'local' anesthetic is included/bundled into the procedures. It is considered an 'integral' part of preparing the site for the procedure.