Wiki Steroid and visc injections

Create Wiki
L

lisak0727

Contributor
Messages
11
Location
Friedensburg, PA
Best answers
0
Our orthopedic practice is having trouble getting visc injections and steroid injections covered. We use the procedure code 20610.
We also use M17.0 - M.17.9 diagnosis codes. We are getting rejected for experimental and do not understand why.

Any assistance would be greatly appreciated.
 
Probably not your coding that is getting these denied

Some insurance will pay for synvisc and other similar injections, some won't. BX is famous for denying these as experimental and has not paid on these for quite a while now.

I don't think your coding is the issue, I would look to the insurance and see if they even cover this.
 
I wouldn't think you would have an issue getting the cortisone injections paid by any insurance. For the Visco injections the osteo diagnosis codes are the ones that pay. We had some issues with getting an auth but it was because we needed to show failed cortisone and PT instead of going straight to the Visco injections.

It may be the specific insurance carrier and they may have their own policy on those specific injections. I would check with each insurance carrier that is giving you that denial and get more clarification.
 
First do not use a dx code for an unspecified body part.
Second for osteoarthritis we are allowed to default to primary so do not use unspecified osteoarthritis (ie M17.9)
Third be certain you are coding the medical necessity for the injection. For instance
The steroid does not treat the osteoarthritis, it treats the pain caused by the osteoarthritis. Be certain your provider has documented chronic pain or acute pain and not just pain. Then you use the G89 code first listed and the M17 code secondary to show site and cause ( see pain coding guidelines)
The visc treats the condition of the osteoarthritis so you use the appropriate code for the osteoarthritis such as M17.11 but never unspecified knee or unspecified type.
 
You must log in or register to reply here.
Top