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Thread: Help needed for Medicare injections

  1. #1

    Default Help needed for Medicare injections

    AAPC: Back to School
    We need some help coding and billing Medicare patients that receive an injection.
    We are billing out a 99213-25 , 20605, and the meds. The problem we are having is Medicare is not allowing us to use the 715.94 Osteoarthritis of the Hand as a DX. Do you all have another DX that is getting paid?

  2. #2


    According to Ingenix - that is a payable diag. What kind of rejection are you getting?

  3. #3
    Join Date
    Apr 2007
    Columbia, MO


    If you are giving the injection for pain then you need a pain code (338.1x or 338.2x listed first with the 715.94 listed second and link only the pain code to the 20605 and the drug.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4


    Quote Originally Posted by tdml97@yahoo.com View Post
    According to Ingenix - that is a payable diag. What kind of rejection are you getting?
    Thanks. We have had few different rejections. Anywhere from wrong DX code and second, that we should use a different procedure code.

    Thanks again.
    Lisa O.

  5. #5

    Default Where is injection?

    We usually perform this procedure for shoulders and knees using 715.96, 715.91 without a problem but I haven't had experience with the hand. I was thinking....where exactly is the injection? Perhaps because you are coding the 715.94 for the hand they are flagging this as a 20600 for small joint (as in fingers). Is it possible that for the wrist (which would be billable as a 20605) the appropriate Dx would be 715.93 for the forearm?

    Just a thought. Otherwise I cannot figure out for the life of me why you would not be getting paid.
    Good luck!


  6. #6


    You could be having a problem because of the 9 in the 4th digit; we use 715.14, which is more specific and is also accurate.

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