Wiki trigger point denial

[sdaniel]

Can someone help me with the following:

pain mgmt: pt had two levels of facet joint injection with fluoro., as well as 1 trigger point injection. United HealthCare has denied the 20052 for the reason that it is not a seperately reimbursable srvc

Should modifier 59 be attached to 20552

thanks

 

[susiekay]

yes add modifier 59

 

[smcbroom]

you may also want to look at your diagnosis code to support medical necessity for the TPI. Just a thought~

 

[mitchellde]

Agree the 59 modifier and look at dx, I have seen claims where inadvertantly all dx were linked to each procedure which did cause line items to deny for medical necessity.