“We performed a heel injection on the right foot for a patient with plantar fasciitis. I used CPT 20550 -RT. UnitedHealthcare denied the claim stating we could not prove we injected a substance on a CPT code that requires it. I discussed this with the “MARS” auditor and that was her comment. Any suggestions on why this was denied and how to correct it?”
It never stops! It just keeps on coming! The commercial health insurance carriers and the Medicare Advantage plans keep coming up with reasons to reject claims for reimbursement despite the fact that they are submitted correctly. The above question is a prime example.
So, a patient has plantar fasciitis affecting the right foot. An injection was administered into the right heel for plantar fasciitis. I am making the assumption that the medication that was administered was a corticosteroid. The correct CPT code to bill for this injection is CPT 20550 which was the CPT code that was billed by the physician. CPT 20550 is defined as the following: Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar “fascia”). How much more specific does one have to be? The AMA description/definition of the CPT code specifies PLANTAR FASCIA! The reason for the claim rejection by United Healthcare was that it could not be proven that a substance was injected on a CPT code that requires it. What is one to do?
It is important to bill for the corticosteroid that was injected into the plantar fascia on the date of service in question. The HCPCS Level II code, the J code for the corticosteroid that was administered needs to be accessed and billed for the number of units that were injected. Additionally, the NDC number of the medication needs to be accessed and submitted on the claim, as well. The NDC, or National Drug Code, is a unique 10-digit, 3-segment number. It is a universal product identifier for human drugs in the United States. The code is present on all nonprescription (OTC) and prescription medication packages and inserts in the US.
This is my opinion.
Michael G. Warshaw, DPM, CPC
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