Wiki Medicare denying Ultrasound Guidance used with Regional Block Placement

[Billing500]

Since January, CMS has been denying about 85% of our claims for ultrasound guidance 76942-26. Our anesthesiologists use ultrasound guidance when placing nerve blocks for post-operative pain control (sciatic/femoral/etc).

Some of our appeals have resulted in the claim being reprocessed, but Medicare's decision on most remains unfavorable. CMS states "The service was denied because the information provided did not support the need for this service." Our Anesthesia Notes contain a Regional Block section, which contains a copy of the ultrasound guidance photo.

Have any other groups experienced this systemic denial of ultrasound guidance? If so, what was your ultimate solution? My next step is to write a more extensive appeal letter, including medical journal articles which support this technique. Ironically, a small percentage of our claims process just fine!

 

[danskangel313]

Out of curiosity, what DX codes are you using? Are some being denied more than others? Also, are the nerve blocks being ordered by the surgeon? Are they being placed immediately after surgery? I've read some information about this, which is why I'm asking.

 

[Billing500]

The nerve block is placed before the patient is induced for purposes of post-operative pain control. This is ordered by the surgeon and we have an entire page of our medical notes dedicated to Regional Nerve Blocks (including the name of the ordering surgeon, ultrasound guidance picture, and the usual verbiage required).

The primary diagnosis code is the same as the anesthesia and the secondary diagnosis code is G89.18

 

[LisaAlonso23]

For pain management procedures for post-op pain, the primary dx should be G89.18. It should not be the same as the anesthesia dx. They are 2 different procedures provided for 2 different reasons.