Wiki 20550 vs 20610

Create Wiki
T

twinpw

Guest
Messages
41
Location
Cocoa, Florida
Best answers
0
I am a new coder and would like help with a rejected bill. In the clinic, the doctor did a DepoMedrol 80mg injection in right shoulder. Proceure orders state "injection tendon". It was billed as a 20550, 99212 -25 modifier and J1040. It came back as a "medical necessity error". Also states "Coverage of this procedure with the given Dx is not covered (726.90 Capsulitis, tendinitis, periarthritis or other enthesopathy) based on the official Medical Review Policy". How would I fix this? I thought 20610 -RT, 99212 -25, J1030 X 2 would work. What do you suggest, and why? Thanks, Pam
 
the code you selected is
726.90 Enthesopathy of unspecified site
you will need a specific code. The payers are all starting to reject procedures when paired to unspecified dx codes.
 
And you should code what is documented - a tendon injection. If it isn't documented as a "joint" injection, you should not change the CPT code just to get it paid. That would be considered fraudulent. Before you change the cpt code, you should check with the provider for clarification and ask for ammended documentation when appropriate. Unfortunately, some things we do may not be considered medically necessary by a particular payer, but that does not mean you should report an innacurate code. Being a new coder, this is something you need to keep in mind on all encounters. Sorry - didn't mean to lecture....
 
Thank you OliveJ for your bit of info re: jt. inject. vs. tendon inject. I have been pondering what dr. says he is doing and the codes being selected. The office keeps picking 20551 when notes says subacromial joint. I have been questioning the charges but in the same time of being new, I was wondering if I wasn't reading correctly all I have been researching. I feel better now and will speak to office about this.
 
You must log in or register to reply here.
Top