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Injections

  1. #1
    Location
    bloomington il
    Posts
    14
    Question Injections
    Medical Coding Books
    We got a eob back from medicare denying a claim for a office visit after giving a 2nd 20610 injection in the knee. Patient had her first one in April and then she had another one in June. We used modifier 25 but they denied it saying it in in the post op period. What can I use to get this to go thru medicare. Different code or modifier?

    thanks
    Last edited by leastham; 07-29-2010 at 10:57 AM.

  2. #2
    Location
    Long Island/New York
    Posts
    1,271
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    Quote Originally Posted by leastham View Post
    We got a eob back from medicare denying a claim for a office visit after giving a 2nd 20610 injection in the knee. Patient had her first one in April and then she had another one in June. We used modifier 25 but they denied it saying it in in the post op period. What can I use to get this to go thru medicare. Different code or modifier?

    thanks
    20610 has no global days. Did the patient have a surgical procedure (menisectomy, chondroplasty) in the past 90 days? I would start there.

  3. #3
    Location
    Greater Pittsburgh
    Posts
    390
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    if it truly is not in the global and Medicare is denying for such, try 24,25.
    jdemar, CPC, CMA

  4. #4
    Location
    Columbus, OH
    Posts
    76
    Default
    You may want to look at whether the E/M is really billable. If the patient came in for the purpose of receiving the injection and wasn't evaluated for a different issue, the E/M isn't billable, it's inclusive to the injection. We've gotten denials like the one you described and that ended up being the issue.
    Kathy Daniel, CPC, COSC

  5. #5
    Location
    Greater Pittsburgh
    Posts
    390
    Default
    Ahhh, I agree with KDaniel, you mentioned "the 2nd was given", could this be for Synvisc or a planned series? If so you can only bill for the initial O/V and then the follow up injections and not follow up E/M because the series of injections was already planned at the inital O/V.
    jdemar, CPC, CMA

  6. #6
    Location
    Columbia, MO
    Posts
    12,531
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    You cannot bill an E&M with a 25 modifier when the procedure is planned as in a planned second injection. You bill the inject and the J code only.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Location
    Greeley, Colorado
    Posts
    2,045
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    Quote Originally Posted by leastham View Post
    We got a eob back from medicare denying a claim for a office visit after giving a 2nd 20610 injection in the knee. Patient had her first one in April and then she had another one in June. We used modifier 25 but they denied it saying it in in the post op period. What can I use to get this to go thru medicare. Different code or modifier?

    thanks
    Is the denial for 20610 or an e/m? You can only use -25 on e/m codes. And as someone else asked, did the patient have knee surgery on the knee being injected within the last 90 days?
    Lisa Bledsoe, CPC, CPMA

  8. #8
    Default injection
    I agree with Kdaniels. I just recently found out that if patient is coming in to receive injection that was discussed on earlier visit you can't file an E/M and injection code unless the patient was being seen for something different. This was in a webinar offered by AAPC to prepare for COSC exam.

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