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Injection modifier? (united healthcare)

  1. #1
    Default Injection modifier? (united healthcare)
    Clearnace Sale
    Good afternoon all,

    I am wondering if somebody could assist me in a denial from United Healthcare on a office injection (20552). United Healthcare is saying that his code needs a modifer, and after reading the procedure note, I am still unsure. The PA coded this visit on the billing sheet as 99213, 20552 x2.

    Im thinking 59 modifier as the 2 injections were in two different parts of the spine. Am I right?

    "PROCEDURE NOTE: After explaining the risks of the procedure such as bleeding, infection, pain, nerve injury, skin atrophy, fat pad atrophy, skin color changes among others, the patient consented to having the injections performed. After isolating both the superior and inferior trigger points on the right side of spine, rhomboids, after sterile prep ethyl chloride spray was used for anesthetic. Under sterile procedure, a 20 gauge 1-inch needle was used to enter the trigger point. No heme was able to be aspirated. At this point, in a fanning motion approximately 6 cc of 50% bupivacaine, 0.25% and 50%, 2% lidocaine with approximately 20 mg of Kenalog was injected into the area without difficulty.Direct pressure was held for hemostasis. This process was repeated on the inferior trigger point without complication."

    Thank you for your assistance!
    Last edited by marci_ann; 12-15-2009 at 01:08 PM.
    Marci A. Giardina, CPC

  2. Default
    My interpretation of the code is that 20552 is billed x1 only to represent injections into 1 or 2 muscles; If 3 or more muscles are injected (no matter the location or the number of injections into each muscle) then 20553 x1 only would be billed. The pertinent question is- how many different muscles were injected? Then choose the correct code and bill it once.

  3. #3
    Greeley, Colorado
    I agree with swhite3. You also need modifier -25 on the E/M. Remember - the E/M can only be coded if it meets the significant separately identifiable definition. If the patient was scheduled for the injection procedure then the E/M is not reportable.
    Lisa Bledsoe, CPC, CPMA

  4. Default

    Yes I also agree with swhite3 & Lisa, and if the injection was not scheduled or planned for that visit or for some other reason, you should match your visit with a modifier 25 to a Dx (why the Patient made that visit) and the injection to a Dx (why the provider made that injection).

    Hope this can help


  5. #5
    This is an ongoing hot issue in my office as well. I too agree with swhite3 & Lisa. I found this link resourceful for me Once there, click on the third one from the bottom. Best wishes!

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