Wiki Coventry and 20611 denials

Create Wiki
I

iowagirl77

Expert
Messages
278
Location
Cedar Rapids, IA
Best answers
0
Has anyone else had issues with Coventry lately denying 20611 as not medically necessary per LCD? The only LCD I can find is for injections of the knee with hyaluronan. However, the ones that are denying are not being injected with hyaluronan and may be in any of the major joints, not just knees. We've tried appealing stating it is not related to the LCD, but denial was upheld. We are usually billing with a diagnosis of osteoarthritis for the related joint. Thoughts?

Thanks!
 
You should look at the drug being given and what its task is.. If the drug is to relieve pain then you need a G89 code for the pain listed first. Read the pain guidelines. If the drug is directly treating the OA like synvisc then the OA is the first listed code. I have often found this is the problem.
 
They have generally been billed with a pain code primary when billing 20610 or 20611 with J3301, such as M25.511 followed by the condition. We haven't billed with a G89 code, but this has never been an issue with any payer previously. It is worth a shot. Thanks!
 
you would not use the M25 code with the M17 code for pain in knee due to OA .. you use the G89 for acute or chronic pain with the M17 code for acute or chronic pain in knee due to OA. The pain guidelines state when the reason for the encounter is pain management/control then a G89 code should be first listed.
 
I was able to reach Coventry and they are denying incorrectly. They said it denied due to LCD A56157, but that only is for knee viscosupplementation injections. This has been denying on claims with steroid injections of any of the major joints, so we will appeal further.
 
You must log in or register to reply here.
Top