“I have been getting denials from BCBS, First Care, Aetna, and UHC on claims billed out with diagnosis codes M72.2, M71.571, M71.572, M77.31, and M77.32. Has anyone else had this problem lately? The NDC number and the description are on the claim. The claim is going out as follows: CPT 99213 25, CPT 20550 RT, CPT 20550 LT, J0702 x 2 units, J1030 x 2 units.”
Just about one week ago, there was a similar question that needed to be addressed. The CPT code in question was CPT code 64455 which is defined as: Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (e.g. Morton’s neuroma). The issue was getting reimbursed for bilateral Morton’s neuroma injections. When based upon the CPT code description, the health insurance carriers do not want to reimburse for more than one injection on the same date of service. I sort of understand not reimbursing for more than one injection on the same foot, but what about administering bilateral injections? That is what my response addressed and opined.
This is deja vu all over again! The issue now is CPT code 20550 which is defined as: Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar “fascia”). Once again, it appears that the health insurance carriers do not want to reimburse for more than one injection using this CPT code on the same date of service. I guess that the health insurance carriers can make an argument for not reimbursing for administering more than one injection into the same foot, but what about administering bilateral injections as described in the above scenario?
Here is my take:
In order to bill for CPT code 20550 bilaterally, I believe that there are two viable options:
CPT 20550 – 50 (M72.2)
The 50 modifier identifies a BILATERAL PROCEDURE. In this instance CPT code 20550 would be billed at 1 unit since the 50 modifier automatically implies 2 units and the fee for performing the procedure one time would be doubled.
CPT 20550 – RT (M72.2)
CPT 20550 – 59, LT (M72.2)
The 59 modifier identifies a DISTINCT PROCEDURAL SERVICE. I would then go up to BOX 19 on the CMS 1500 Claim Form or the electronic equivalent, the Information Box. I would type in the following: “Two separate injections injected into two separate anatomical sites on two separate feet.”
One of these two options should achieve reimbursement. If not, I just gave you terrific grounds for an appeal.
This is my opinion.
Michael G. Warshaw
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