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lumbar puncture to administer intrathecal chemotheraphy

Miriam Posted Tue 18th of November, 2014 20:42:36 PM

we are having problems these getting claims paid. If you were to read the following report how would you code? we have been billing 77003-26,96450 with no luck (especially to Medicare)
EXAM:
- GD LUMBAR PUNCTURE WITH FLUOROSCOPIC GUIDANCE AND ADMINISTRATION OF INTRATHECAL CHEMOTHERAPY

Exam date - 11/17/2014 10:44 AM

CLINICAL HISTORY:
Lymphoma

TECHNIQUE AND FINDINGS:
The patient was placed on the fluoroscopy table in the prone position. The L1-L2 level was identified fluoroscopically. Following sterile preparation of the skin and introduction of local anesthesia, lumbar puncture was performed with a 20-gauge spinal needle. 6 mL of CSF were obtained and sent to the laboratory for cytology and flow cytometry. 12 mg of methotrexate were then administered over 3 minutes. The needle was removed. There were no immediate complications.

IMPRESSION:
Lumbar puncture was performed with fluoroscopic guidance. 12 mg of methotrexate were given intrathecally.

FLUOROSCOPY TIME:
0.7 minutes.

SuperCoder Answered Wed 19th of November, 2014 08:32:58 AM

Your coding is correct. What denial do you get?

Miriam Posted Wed 19th of November, 2014 13:08:35 PM

our denial code was B15. So we contacted Medicare to see what it is including with. Medicare is stating we need to include the chemotherapy drug (which is hcpc codes that we don't bill for as we are billing only for the physician. We tried including B19 note stating the hcpc code and the amount of the drug administered but still is not working.
I was thinking we MUST be doing something wrong, but glad to see you would have coded the same way. Not sure what to do next as we tried appealing and appeal denied and Medicare is not being forthcoming with what they are really looking for. Any help or ideas would be much appreciated at this point.

SuperCoder Answered Fri 21st of November, 2014 09:30:38 AM

I believe you should call the Medicare and ask for specific information they want to get it through.

Thanks !!

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