Coding, Classification and Reimbursement

MA and Medicare Denials - Pain Injections

  • 1.  MA and Medicare Denials - Pain Injections

    Posted 13 days ago
    Edited by Misty Sanchez 13 days ago
    Some Medicare/ MA claims for RFA; epidural steroid pain injections; and para-vertebral facet joint pain injection services performed at our surgical hospital have been denied. Per remarks by payer on the claim "These are non covered services because this is not deemed a 'medical necessity' by the payer." However, other payers are covering these same pain management procedure. So far, we aren't finding any common thread on these cases. We've reviewed these claims and it appears that all required codes w/ modifiers are present. -(e.g. ICD-10-CM diagnosis codes, CPT codes for pain injections and conscious sedation, and HCPCS for anesthetics and steroids used) Any help or advice would be appreciated. Thank You.

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    Misty Sanchez
    HIM-Coder
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