05/14/2021

Empire Denial-76882-Included in Another Service

Established patient, new problem. 04/29/2021 Pain in 1st MP joint. Workup done, diagnostic sonogram on joint. Diagnosis of M25.572 pain in joints, M25.476 effusion. CPT of 99213-25, 76882-Lt, 20600-Lt, J code. Blue cross rejected 76882 saying it was including in another service

The ultrasound was denied correctly by Empire- when these injections are performed, CPT 20600 (DRAIN/INJ JOINT/BURSA W/O US) should only be billed if there is no ultrasound or imaging guidance done on the same encounter. If there was an ultrasound performed on the same encounter, the correct CPT code that should be billed is CPT 20604 (DRAIN/INJ JOINT/BURSA W/ US). If the two services are billed as separate line items, the unbundling on the claim will cause a denial of one or both of the line items, depending on the payer. If a corrected claim is submitted to Empire with the corrected coding, it should provide higher reimbursement to reflect both the pain management procedure and imaging guidance.