Synvisc WC

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Does anyone have any advice on billing WC for a synvisc injection? I have two patients, both with State Insurance Fund, and I can not get payment on either case. Thanks for the help!
 
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Does anyone have any advice on billing WC for a synvisc injection? I have two patients, both with State Insurance Fund, and I can not get payment on either case. Thanks for the help!

What codes are you billing out and what is/are the denial reason(s)?
 
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4
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What codes are you billing out and what is/are the denial reason(s)?

I have two cases, both I have a diagnosis code of M17.11. I have tried the following :

E1399 + 99213--- duplicate of paid procedure--- which makes no sense as they have not paid the synvisc fee just the visit fee.

1) J7325 + 99024--- Hcpcs level ii codes are not reimbursable services per the ny medical fee schedule. Materials supplies by physicians should be billed with code 99070 and repriced per invoice.
2) 20610 + 99070 --- I have not heard back on these codes yet.


Sorry, I am fairly new to coding and the person I took over for was unable to get payment on injections so I would like to be able to rectify the situation. I appreciate your help!
 
Messages
811
Best answers
0
I have two cases, both I have a diagnosis code of M17.11. I have tried the following :

E1399 + 99213--- duplicate of paid procedure--- which makes no sense as they have not paid the synvisc fee just the visit fee.

1) J7325 + 99024--- Hcpcs level ii codes are not reimbursable services per the ny medical fee schedule. Materials supplies by physicians should be billed with code 99070 and repriced per invoice.
2) 20610 + 99070 --- I have not heard back on these codes yet.


Sorry, I am fairly new to coding and the person I took over for was unable to get payment on injections so I would like to be able to rectify the situation. I appreciate your help!

I think the main issue is that they will not pay for any supplies, drugs, etc that would normally be considered inclusive to an office visit or procedure, as decided by them.

E1399 is used to report DME (devices, not drugs). The "duplicate" denial is likely their way of saying that the items reported by E1399 are included in the office visit.

Since they don't reimburse HCPCS codes, there's no other option (apparently) other than to report 99070. They may reimburse the synvisc, but not when billed with a HCPCS code.

If this is during a post op period, billing 20610 might get denied for bundling. Aside from that, billing 20610 + 99070 could really go one of two ways depending on whether or not they consider the drug inclusive. 20610 reports a service that can include the injection of a therapeutic drug, so they may consider the drug supply a normal component of the procedure and deny it for bundling. I wouldn't hold my breath on this one.
 
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