Question Trigger Point Injections and Anthem

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1
Location
LaPorte, IN
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We are a new medically integrated practice in Indiana. We are billing Trigger Point Injections to Anthem BCBS 20552 and 20553. Anthem is denying the code because an accompanying procedure is missing on the same date of service. We were told by a billing company not to bill with an exam and not to bill with Lidocaine . Since Lidocaine does not have a code. However other sources say to bill the Lidocaine with J3490. We have been told to bill with ultrasound guidance. We did and it was still denied. I am really confused as to what to do next. Has anyone had this same problem? We have no problems with other payers paying for these codes.
 

SharonCollachi

True Blue
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2,173
Location
Clovis, CA
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Your Anthem may be different than my Anthem (in California, it is Anthem Blue Cross of California; Blue Shield is a completely separate company).

Last year Anthem stopped paying for trigger point injections with an E&M code. You could have the visit or the trigger points, but not both. Now at a visit we make the decision to do trigger points and schedule them for another day (we are pain management and the patient is coming in for monthly visit for medication review, among other things).

Anthem won't pay for an injection without a medication, even if that medication cost is zero. Lidocaine is usually bundled into the injection, but again, you have to go by what the payer has decided is right (as long as there is no fraud or other moral/ethical objection). We almost never do trigger points without depomedrol, or kenalog, or dexamethasone in addition to the lido (we use a 50/50 mixture of lidocaine and marcaine), so that's usually not an issue for us.

So I think the real issue is that you're billing an injection but not indicating the drug, which could lead them to think you're dry-needling, which is always considered experimental and therefore not covered. So you could bill the unlisted code J3490 if you want, or some say you could bill J2001 with a zero dollar amount (or one cent if your billing program won't let you do zero dollar charges).
 

vgriffin

Contributor
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18
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Your Anthem may be different than my Anthem (in California, it is Anthem Blue Cross of California; Blue Shield is a completely separate company).

Last year Anthem stopped paying for trigger point injections with an E&M code. You could have the visit or the trigger points, but not both. Now at a visit we make the decision to do trigger points and schedule them for another day (we are pain management and the patient is coming in for monthly visit for medication review, among other things).

Anthem won't pay for an injection without a medication, even if that medication cost is zero. Lidocaine is usually bundled into the injection, but again, you have to go by what the payer has decided is right (as long as there is no fraud or other moral/ethical objection). We almost never do trigger points without depomedrol, or kenalog, or dexamethasone in addition to the lido (we use a 50/50 mixture of lidocaine and marcaine), so that's usually not an issue for us.

So I think the real issue is that you're billing an injection but not indicating the drug, which could lead them to think you're dry-needling, which is always considered experimental and therefore not covered. So you could bill the unlisted code J3490 if you want, or some say you could bill J2001 with a zero dollar amount (or one cent if your billing program won't let you do zero dollar charges).
Do you happen to have the BC of CA link to this policy? I am new to family practice coding, only 1 month, after billing Cardiac Surgery for 20 years and I am still gathering payer guidelines. I would truly appreciate it.
 

fami

Networker
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CULVER CITY CHAPTER
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Do you happen to have the BC of CA link to this policy? I am new to family practice coding, only 1 month, after billing Cardiac Surgery for 20 years and I am still gathering payer guidelines. I would truly appreciate it.
HI All, if there is a procedure code, could not bill the EM along with it. The procedure either scheduled / not in advance. Either way just bill the injection w/ anatomical modifier [if applicable]; and medication does.
 
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