96372 with 20610

I'm getting denials from MCR for billing 96372 with 20610; only 20610 is getting paid. I am billing: 99214-25, 96372-51, J1040, 20610-59, J3301.

Claims are being denied for bundled codes.

I am also getting a denial for 20552-51, 20610-59. Any suggestions please?

re: 96372 with 20610

Why would you bill the 96372 with 20610 anyway? One is for an intramuscular or sub-q injection and one is for an injection or aspiration of a major joint or bursa. They are very clearly 2 separate procedures. In my experience, generally, the 96372 is bundled into an E/M code and is not separately payble. As far as the 20552 and 20610, there would be no need to put a 59 on the 20610. It has the higher RVU, so the 59 should go on the 20552, providing it truly is a separate procedure. You don't need a 51 on either.

re: 96372 with 20610

99213-dx-Rheumatoid Arthritis, Osteo, and Degenerative Joint Dz
96372- dx-back pain
20610-dx joint pain
Should I use any modifiers on this?

The dr gives joint injections along with the nurse giving sub-q injections for diff dx.

20610-shoulder injection and 20552-neck injection, I should bill with 59 on 20552 and both codes should be paid?

re: 96372 with 20610

99213-25 : dx RA, OA, DJD
96372 (not billable - bundled in E/M)
20610 with laterality modifier RT/LT
IF a trigger point injection is given for the neck, you would append a 59 modifier to the 20552, but make sure you have a medically necessary diagnosis or it still won't be paid.

Hope this makes sense.

re: 96372 with 20610

ok makes sense! Thank you! I appreciate it!