Wiki Reimbursement denied for CMC and Carpal Tunnel Injections When Done on Opposite Limb?

[cclarson]

A patient has bilateral carpal tunnel syndrome and CMC arthritis. The patient went in for surgery to correct the Carpal and CMC for the right limb, but injections were done at the same time on the left limb. Now insurance is denying reimbursement for the injections, even though they were done on the opposite limb from the other procedures, and I made sure to use the LT/RT modifiers. Can I appeal this, or is that just how it is?

I sent a message over to BCBS, who stated: "I have researched your question and found that line 05 20526 and line 06 20605 are not independent procedures in this place of service. Therefore, the procedures are not separately reimbursed."

Any thoughts?

 

[SharonCollachi]

Injections done at the time of another procedure are often denied or considered incidental and not separately reimbursable. They're already there for the surgery, and the additional work for the injection is considered minor. Not saying it's right; saying it's my experience.

 

[cclarson]

Injections done at the time of another procedure are often denied or considered incidental and not separately reimbursable. They're already there for the surgery, and the additional work for the injection is considered minor. Not saying it's right; saying it's my experience.

Thank you Just unfortunate that it's bundled like that when it's a different limb.