Wiki Denied E & M

[tdiederich]

Just recently our E & M codes are being denied when we are also perfomring a cortisone injection. For most of these cases, the patient has not been seen for 6 months to a year and are scheduled due to pain in joint. Our physicians normally do a comprehensive exam prior to offering the injection. Normal CPT codes:

99213-25
20610
J1030

The insurance companies that are denying these are private payors. Is anyone else also experiencing these denials? Any input would be appreciated.

Thanks,

Tisha Diederich, PCS,CPC

 

[valshriver]

I have had several payer's also do this lately. I called them and sent notes
with a paper claim and they reprocessed them and paid.

 

[tdiederich]

Thanks for the response.

 

[Bella Cullen]

I wouldn't go putting a 59 mod on 20610, that is incorrect coding. The way you have it is correct. I haven't had any problems getting them paid.

 

[mitchellde]

I agree with ILuvRock. Many times payers deny because they want to be certain you can appeal with correct documentation, you just have to play the game, but the standard is three, meaning a particular payer will usually deny the same thing three times and as long as you appeal successfully three times in a row then they will ordinarily leave it be from then on, if not I would send a letter to the supervisor.