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any billing coders out there? Medicare denied claim 1400

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  • any billing coders out there? Medicare denied claim 1400

    I have a question. Mecaire denied my trigger point injections , which were billed under muscle, plantar, joint injections because they said the code that was used doesnt allow that many injections in such a short period and there was NO supporting documents for necessity.

    When I had Aetna insurance this office coded these injections as surgery.

    Any ideas on why this wasnt put thru the same with medicare?

    Im going into battle on this one, the office hasnt called me back.

    thanks for any insight or help.


    Lyme disease diagnosed 11/05
    vulvar vestibulitis diagnosed 2/06 -worst case she has ever seen..very bad.
    IC diagnosed with hydro/cysto- may 17, 2006

    Over growth of lactobicilli found 8/07 treating with doxy.

    Was able to get my first internal exam evaluation for PFD....wohoo 1/18/07:woohoo:

    8/22/07- was able to get my first speculum exam, with pap

    Strep D found in bladder with United medical labs May 2006
    2 strains of strep in stool culture 9/06
    high Strep ASO titre found 10/06

    NEW MED

    Capsasin cream-once a day for 20min,
    BUt wont lie it does burn

    About to start valium supositories for PFD

    Trigger point injections- oct 07

    Current meds:
    Neurontin- 100mg at night supposed to work up to 300mg if i can tolerate it
    Zanaflex 2mg
    IC and low oxalate diet, no sugar diet
    Xanax for appointments to help relax me since they cause so much pain

    Started PT 3/07, PT has really helped me in ways I never knew that it would

    Meds ive tried
    Lyrica
    Klonopin
    Singulair
    Claritin
    Pyridium
    Soma- can barely tolerate half a pill
    Atropine cream- didnt seem to work, although i found out I was applying the creams wrong
    Estradiol cream
    Urelle- caused worse bladder spasm and retention

    Various antibiotics for lyme which caused yeast and made the IC and VV worse

    waiting for the next chronic illness to pop up


    "Did you know?
    Every 15 seconds,
    a person is
    diagnosed with
    interstitial cystitis."
    Source: J. Dimitrakov, MD

  • #2
    It could be a coding error but the one as an injection makes more sense.. Why would tpi's be a surgery? My mom did coding forever I'll ask her tomorrow
    With Lots of Love and Wishes for Pain Free Days~Heather

    ~I was diagnosed with Interstitial Cystitis at the age of 23, 4 months after getting married. I also have severe Endometriosis, Adhesion Disease and Pelvic Floor Dysfunction. All of which were diagnosed AFTER being diagnosed with IC. Before IC my only health issues were a history of migraines since I was a child and a battle with cervical dysplasia. I had a LEEP in 2007 and have been clear of the cancerous cells since.~

    ~Please feel free to PM me if you have any questions, concerns or comments. Or if you just need a friend, someone to listen. I am almost always lurking around online somewhere. LOL~

    Comment


    • #3
      I have trigger point injections at my pain clinic and they always bill them as surgery as well.
      Current diagnosis
      Severe IC, Severe Endometriosis(keeps growing back all over despite surgeries and treatment), Chronic ovarian cysts, Chronic Pelvic Pain Syndrome,Fibromyalgia,Inguinal hernia, bursititis of the hip, Migraines, IBS, Celiac disease, CROHN'S Disease, Chronic Constipation, Chronic anal fissures, Vulvodynia, Pelvic Floor Dysfunction, Pirisformis muscle spasms,vulvar vestibulitis, chronic insomnia, Burning Mouth Syndrome, Brain TUMOR, Chronic Lyme Disease,Temporomandibular Joint Disorder,Degenerative disc disease,Arthritis.
      Allergies: Elmiron, Levaquin, Sulfa-Anaphylactic shock,Morphine, Doxyclycline,Cipro

      Treatments I have tried:Bladder instillations, Oral meds-Elmiron, Elavil (amitryptyline), Hydroxyzine (Vistaril & Atarax), Ditropan, Levsin, Urispas, Urised, Pyridium, Cystoprotek, Desert HarvestAloe,antibiotics,Ultram,Neurontin,Valium,Tramadol,Lunesta,Ketor olac,Cipro,Meloxicam,Dilaudid,Morphine,Vicoden,Darvocet,oxycontin,Lyri ca,Cymbalta,Nortriptyline,Enblex,Baclofen,Clonidine,oxybutynin,Detrol, Nitroglycerine ,Vesicare,Sanctura(there are more but this is enough)
      Physcial Therapy, Cystoscopy with Hydrodistentions, Numerous Nerve Blocks, Neuromodulation-including Sacral neuromodulation(Interstim) and post-tibial nerve stimulation (Urgent PC-12week), Botox, bladder instills, physical therapy, natural(herbs)Current meds: Long list..just email if you are interested
      Interstim implants--8 plus surgeries for them.
      I am selling IC awareness bracelets, keychains, pens and pins..if interested please email me! ThanksFeel free to email me at [email protected].
      One day at a time

      Comment


      • #4
        Spoke to my mom. Call your dr. he needs to send a letter of medical necessity of why you need these injections so often. It is not an issue of the injections themselves it is an issue about the amount and frequency of the injections. Medicare will say on a base line they will only cover x amount of injection over x period of time. They will approve off the base line but need a letter from your dr stating the necessity. Like I take 12 percocet per day. Medicade only pays for 8 per day so every other rx I have to pay cash price for because in Meicaids eyes I got 100 and only get 8 a day that should last 13 days when in reality it is 12 a day and only lasts 8 days so they look at my next rx as an early refill and will not cover it. My dr is working on getting that approved.Hope this helped.
        With Lots of Love and Wishes for Pain Free Days~Heather

        ~I was diagnosed with Interstitial Cystitis at the age of 23, 4 months after getting married. I also have severe Endometriosis, Adhesion Disease and Pelvic Floor Dysfunction. All of which were diagnosed AFTER being diagnosed with IC. Before IC my only health issues were a history of migraines since I was a child and a battle with cervical dysplasia. I had a LEEP in 2007 and have been clear of the cancerous cells since.~

        ~Please feel free to PM me if you have any questions, concerns or comments. Or if you just need a friend, someone to listen. I am almost always lurking around online somewhere. LOL~

        Comment

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