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Wiki multiple trigger finger injection

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keelyjn.hollen@gmail.com

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Having difficulty being paid for multiple trigger finger injections. Have been trying every combination of modifiers and still not having luck.
have tried entering each on a line with the finger mod, have tried using 59 on subsequent lines, have tried using qty increase on one line? Running out of options and could use some help please.
 
How many are they doing in one session/day? If you are running up against the MUE limit according to the payer, there may not be anything you can do about it.
Is it only one carrier or all? What is the denial reason, we would need to know why it is being rejected or denied. Are any of them bilateral? Are they doing too many within a specific timeframe as defined by the carrier? Is everything coded correctly? Basic question but...

Effective: 1-Jan-25
MUE value for 20550: 5
MAI: 3 Date of Service Edit: Clinical
MUE Rationale: Clinical: Data


An example LCD article:
"The clinical record should include the elements leading to the diagnosis and treatment decision to use injection. If the number of injections exceeds three to the same site or local area in a six month period, the record must justify these added injections since the presumed need for further injections should raise the issues of correct diagnosis or correct choice of therapy as well as concerns for adverse side effects. Records must be made available upon request."
 
But, what is the rejection or denial reason? What is the payer guideline or policy for trigger finger injections? Has the patient had too many. You need to figure out the denial reason or rationale.
They might want a 50 on one line for the RT/LT middle.
You also have to make sure only the correct anatomical finger diagnosis is attached to the correct line and not all of them on every line.
Is the drug (J code) being reported correctly?
 
amyjph said:
But, what is the rejection or denial reason? What is the payer guideline or policy for trigger finger injections? Has the patient had too many. You need to figure out the denial reason or rationale.
They might want a 50 on one line for the RT/LT middle.
You also have to make sure only the correct anatomical finger diagnosis is attached to the correct line and not all of them on every line.
Is the drug (J code) being reported correctly?
Click to expand...
They denied for modifier, was not bilateral and I had the correct finger mod and dx applied to each line. I will try to keep track of mods used and try to find the right combination. Thanks anyway
 
They might just want RT/LT mods with the appropriate finger dx attached. Nothing else, no 51, no 59s. One unit only.

20550-LT LT 3rd dx
20550-RT RT 3rd dx
20550-RT RT 4th dx

Technically, if the LT & RT 3rd were being done (from the finger mods you listed above) that would be bilateral (same finger on each side). So it is possible it should be:
20550-50 LT 3rd dx, RT 3rd dx
20550-RT RT 4th dx
One unit only on each.
 
I am having this issue with my Medicare advantage plans. We typically are billing only 1 at a time. I have 2 denials with Humana currently and have already sent medical records. I got a letter today stating "a data element on the claim has been submitted in a manner inconsistent with correct coding direction. When I bill 20550 in the past and used specific area like F6 they would deny and would switch to RT or LT and would pay. That is not the case now. I looked at the CMS A57079 and said "CPT/HCPCS Modifiers N/A" does this mean NO MOD is needed? I also used DX M65.30 which wasn't approved so I am sending a corrected claim with F6 and switched DX to M65.321.

I am not sure if this is going to work so I am totally open to suggestions. This is the first one that they denied after medical records were sent.

HELP
 
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