Last Update: My supervisor says she doesn't want me doing denials. At least, not yet. It was a co-worker who had asked for my help in getting it done. I had wanted to try doing denials anyway, but since I was dropped into the deep end without a float, I felt frustrated and stuck when the co-worker couldn't tell me what I needed to know to get it done because she was in an online meeting. I'll still leave this up here in case anyone else has a similar issue in the future.
2nd Update: Removed modifier 51 and am being told that the J code might be bundled in with the injection procedure code 62323 as well as a potential issue with the POS. Asking my supervisor about the POS issue as well as I can figure out.
Update: I added modifier 51 to J3301 on the claim and have it ready to go back unless anyone here says otherwise.
This is only my second time even attempting to handle denials, so I need some advice with this one. Medicare is denying this claim stating there is a missing modifier for J3301. I'm inclined to think it's missing modifier 51. Help?
Operative Report
Pre-op. Diagnosis:
1.Lumbar radiculitis recalcitrant to conservative management
Post-op. Diagnosis:
1.Same as pre-op diagnosis
Operation:
1.Lumbar epidural steroid injection under fluoroscopic guidance (interlaminar approach)
Anesthesia:
*LOCAL ANESTHETIC INJECTED: 5 mL of 1% lidocaine,
*SEDATION MEDICATIONS: None
Indications:
Persistent lumbago and associated radiculopathy resistant to conservative care options.
Details of Procedure:
LESI
1) L2-3 interlaminar epidural steroid injection.
2) Fluoroscopic needle guidance
TECHNIQUE: Time-out was taken to identify the correct patient, procedure and side prior to starting the procedure. Lying in a prone position, the patient was prepped and draped in the usual sterile fashion using Betadine and a fenestrated drape. The area to be injected was determined under fluoroscopic guidance. Local anesthetic was given by raising a skin wheal and going down to the hub of a 27-gauge 1.25-inch needle. The 3.5-inch 25-gauge Quincke needle was advanced under fluoroscopic guidance. The needle was advanced to the final position via a lateral fluoroscopic intermittent image. Utilizing a loss of resistance technique, we confirmed entrance into the epidural space, and aspiration was negative for heme or CSF. After a negative aspiration, the medication (Kenalog) was then injected.The procedure was completed without complications and was tolerated well. The patient was monitored after the procedure. The patient (or responsible party) was given post-procedure and discharge instructions to follow at home. The patient was discharged in stable condition. A follow-up appointment was made.
Specimens: None
Complications: None
Estimated Blood Loss: NONE
Originally Billed Procedure Codes:
62323
J3301 10 mg
2nd Update: Removed modifier 51 and am being told that the J code might be bundled in with the injection procedure code 62323 as well as a potential issue with the POS. Asking my supervisor about the POS issue as well as I can figure out.
Update: I added modifier 51 to J3301 on the claim and have it ready to go back unless anyone here says otherwise.
This is only my second time even attempting to handle denials, so I need some advice with this one. Medicare is denying this claim stating there is a missing modifier for J3301. I'm inclined to think it's missing modifier 51. Help?
Operative Report
Pre-op. Diagnosis:
1.Lumbar radiculitis recalcitrant to conservative management
Post-op. Diagnosis:
1.Same as pre-op diagnosis
Operation:
1.Lumbar epidural steroid injection under fluoroscopic guidance (interlaminar approach)
Anesthesia:
*LOCAL ANESTHETIC INJECTED: 5 mL of 1% lidocaine,
*SEDATION MEDICATIONS: None
Indications:
Persistent lumbago and associated radiculopathy resistant to conservative care options.
Details of Procedure:
LESI
1) L2-3 interlaminar epidural steroid injection.
2) Fluoroscopic needle guidance
TECHNIQUE: Time-out was taken to identify the correct patient, procedure and side prior to starting the procedure. Lying in a prone position, the patient was prepped and draped in the usual sterile fashion using Betadine and a fenestrated drape. The area to be injected was determined under fluoroscopic guidance. Local anesthetic was given by raising a skin wheal and going down to the hub of a 27-gauge 1.25-inch needle. The 3.5-inch 25-gauge Quincke needle was advanced under fluoroscopic guidance. The needle was advanced to the final position via a lateral fluoroscopic intermittent image. Utilizing a loss of resistance technique, we confirmed entrance into the epidural space, and aspiration was negative for heme or CSF. After a negative aspiration, the medication (Kenalog) was then injected.The procedure was completed without complications and was tolerated well. The patient was monitored after the procedure. The patient (or responsible party) was given post-procedure and discharge instructions to follow at home. The patient was discharged in stable condition. A follow-up appointment was made.
Specimens: None
Complications: None
Estimated Blood Loss: NONE
Originally Billed Procedure Codes:
62323
J3301 10 mg
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