Wiki Need help with coding this for Injection

[twosmek]

Below is the note from the MD. The coding for it was as follows. Getting denial from insurance not liking the ICD-9 Codes
215.2 and 354.9

CPT
20552 and J3490 x 3 (unlisted Medication and Box 19 was completed)

Any and all help would be greatly appreciated.

Thanks

Pt has a neuromatous lesion on the right elbow. It is just medial to the olecranon on the lateral aspect in between the lateral epicondyle and the olecranon. It has been diagnosed previously with the use of local anesthetic. She is in for a Sarapin injection.

OBJECTIVE:
EXTREMITIES: A small fibrotic neuromatous like lesion can be palpated which is the point of tenderness. She has full motion. Her hand is neurovascularly intact.

PLAN:
We discussed the treatment. She elected to go with a trial of Sarapin injection, which is a pitcher plant extract in alcohol base used for neuralgias and neuromas. Three cc of Sarapin were infiltrated around the neuromatous lesion and we hope this offers relief. If it does this can be done as frequent as needed. Follow-up on a p.r.n. basis.

DIAGNOSIS:
Neuroma, right elbow.

 

[josephmglick]

If it is CMS/Medicare I'd look at the LCD from your carrier and if any insurance company that follows Medicare guidelines will probably follow the LCD also.

 

[dingersol]

Sarpin Injections

Trigger Point codes should not be used for Sarapin, the code M0076 should be assigned for these injections and are considered investigational, some payors will cover the service if pre authorized. Billing for the trigger point with the sarapin HCPCS will result in denial of the claim.




“Prolotherapy, the injection into a damaged tissue of an irritant to induce inflammation, is not covered by Medicare. Billing this under the trigger point injection codes is misrepresentation” MEDICARE

The above statement by Medicare is very clear they do not cover this service and billing the way these claims are currently coded is stated by Medicare as “misrepresentation” of services provided, i.e. fraud.

Why change the service to M0076 – Prolotherapy; this is the service and code that correctly identifies the service of Sarapin used for trigger point injections. See below interpretation by AMA in discussing the CPT temporary code M0076.

What is Prolotherapy?
Today the term “prolotherapy” is used for joint, ligament and tendon injections, while “sclerotherapy” is used for the treatment of varicose veins, spider veins, hemorrhoids and other vascular abnormalities.

What is in the solution that is injected?
A. Prolotherapy injections contain natural substances that stimulate the healing response, as well as local anesthetic agents to help with the pain of the injection. Traditional formulas include ingredients such as dextrose, saline, sarapin and procaine or lidocaine.

CPT Assistant Oct. 2013 –
Question: My physician performs a trigger-point injection using a “dry needle” (a syringe which does not contain an injectable). Can I still use 20550, or should another code be reported?

Answer: The intent of code 20550 is to identify the procedure of performing the trigger-point injection itself. The supply of the injectable is reported separately, using an appropriate HCPCS code to identify the specific injectable used. Since the injectable supply is not included as part of the 20550 procedure, if a “dry needle” technique is used, code 20550 may be used to identify the procedure performed.

 

[dingersol]

Sarpin Injections

Trigger Point codes should not be used for Sarapin, the code M0076 should be assigned for these injections and are considered investigational, some payors will cover the service if pre authorized. Billing for the trigger point with the sarapin HCPCS will result in denial of the claim.




“Prolotherapy, the injection into a damaged tissue of an irritant to induce inflammation, is not covered by Medicare. Billing this under the trigger point injection codes is misrepresentation” MEDICARE

The above statement by Medicare is very clear they do not cover this service and billing the way these claims are currently coded is stated by Medicare as “misrepresentation” of services provided, i.e. fraud.

Why change the service to M0076 – Prolotherapy; this is the service and code that correctly identifies the service of Sarapin used for trigger point injections. See below interpretation by AMA in discussing the CPT temporary code M0076.

What is Prolotherapy?
Today the term “prolotherapy” is used for joint, ligament and tendon injections, while “sclerotherapy” is used for the treatment of varicose veins, spider veins, hemorrhoids and other vascular abnormalities.

What is in the solution that is injected?
A. Prolotherapy injections contain natural substances that stimulate the healing response, as well as local anesthetic agents to help with the pain of the injection. Traditional formulas include ingredients such as dextrose, saline, sarapin and procaine or lidocaine.

CPT Assistant Oct. 2013 –
Question: My physician performs a trigger-point injection using a “dry needle” (a syringe which does not contain an injectable). Can I still use 20550, or should another code be reported?

Answer: The intent of code 20550 is to identify the procedure of performing the trigger-point injection itself. The supply of the injectable is reported separately, using an appropriate HCPCS code to identify the specific injectable used. Since the injectable supply is not included as part of the 20550 procedure, if a “dry needle” technique is used, code 20550 may be used to identify the procedure performed.

Debbie
There are several payors - Amerigroup, Aetna and BCAnthem you will be able to pull up and find supportive data for the above recommendations.

 

[daedolos]

20552, right?

Peace
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