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Thread: Injection denials

  1. #1

    Question Injection denials

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    Is anyone else having an issue getting injections paid:

    1) while in a post op period
    2) with an new patient visit?

    We have never had an issue with these and now we have run into 2 major insurances denying the injections with these issues.


  2. #2
    Join Date
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    Lubbock, TX
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    Quote Originally Posted by banderson77 View Post
    Is anyone else having an issue getting injections paid:

    1) while in a post op period
    2) with an new patient visit?

    We have never had an issue with these and now we have run into 2 major insurances denying the injections with these issues.

    What kind of injections? Are just the admin codes denying, or the product, too? Who's doing the surgery that's tied to the global period?

    Better yet, what does the EOB say is the reason for the denial? We need to know the reason for the denial, to help you figure out the issue. If your provider did the surgery causing post-op period denial, add modifier 79 to the injection code.

    As for the 'new patient' denials - I can't tell you, without more information on the actual denial reason. Never heard of that one before...

  3. #3
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    Location
    Kansas City
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    Medicare and some other insurance companies will not pay for injections in the global period if is related to the surger. They consider it pain management. They will only cover pain management if it requires a return to the OR. If the doc is going to do injections you will get paid for the meds but not the actual administration.

  4. #4

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    Thanks for th help.

  5. #5

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    In order for medicare to pay for the injections you have to make sure that the ICD-9 code has nothing to do with the surgery the patient received prior. Example, if a person just had a spinal surgery, Medicare will pay for an epogen injection for anemia or a synagis injection for a pulmonary patient within the global as long as you only apply the ICD-9 for the injection and none that relate to the surgery. Also, you would need to apply the modifier 24 to the E/M visit code, if you are using one along with the injection code.

    Modifier 24-Unrelated evaluation and management service by the same physician during a postoperative period. or a 79.
    Good Luck!
    Simone

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