Medical Billing Forum
Billing => Billing => : mruiz12 October 24, 2014, 03:45:51 PM
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99215 MOD.25
J1020
J1030
20610
J7030
All of these were paid but i cannot get the insurance to pay pay for the iv
99360
99361
the insurance states it is bundled under cpt code 20610. I have all diagnosis codes where they need to go. I even at one point put a mod. 52 on the 96360. and they still denied. Can someone please help me. I don't know what else to do to get these paid.
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I am confused by the codes...
20610 is arthrocentesis/aspiration and injection.
Then you have 99360: "Code 99360 is used to report physician standby service that is requested by another physician and that involves prolonged physician attendance without direct (face-to-face) patient contact." Why would you bill this with a joint injection given in an outpatient setting?
And you have 99361, which is a deleted code, for a physician team conference. Again, why is this being billed?
Can you see why I am confused? Did you type out the wrong codes in your message?
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Sorry!, yes i did type out the wrong codes. They should be 96360 IV infusion 31 min to 1 hour and 96361 each additional hour. :(
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Okay, I don't feel so confused now! ;D
So let me see if I understand this patient encounter...they came in, had an office visit, had an IV infusion for hydration that went over one hour, and also had an arthrocentesis done on a major joint/bursa? And insurance is bundling the IV infusion for hydration into the arthrocentesis of a major joint/bursa?
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Yes
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So it seems that the insurance company is trying to bundle the joint injection with the infusion...which makes no sense, if they are for two completely different things, with different dx's.
Have you checked your NCCI edits to see if the codes can be unbundled with a 59 modifier if they are for different things, and that there is no MUE on the infusion codes when done at the same encounter as the 20610?
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