Trigger Finger Injections

edited May 2017 in Orthopedics
Has anybody had issues with Aetna Medicare paying for Trigger Finger
injections? When I call, I am told the denial is based on an LCD, but of
course, the rep is not able to tell me the number of the LCD. From what
LCD's I'm finding, it appears that trigger finger diagnoses M65.31-M65.359
are covered diagnoses for 20550. I'm kind of at a loss with this one.



Thanks,



Sandi Hamrick, CPC

Toledo Orthopaedic Surgeons

Comments

  • edited May 2017
    Hi Sandi,



    Are you referring to 26055? That is the trigger finger injection and the dx
    codes you indicated are correct for 26055
  • edited May 2017
    We had the finger modifiers listed on the claim. 
  • edited May 2017
    26055 is the surgical release - I'm asking about a trigger finger injection
    20550.
  • edited May 2017
    They are denying due to diagnosis based on an LCD.
  • edited May 2017
    We bill these to Aetna Medicare and never get denials. We bill the 20550 for the injection with finger mod and then any additional fingers done we bill with 76 modifier (repeat injection) and finger modifier and append the M65.---- dx code to each line to specify which finger also. Hope this helps.
  • edited May 2017
    You are billing the exact way we submitted this claim, except we did not use
    the 76 modifier, we only used the finger modifiers. But they did not deny
    due to modifier, they denied based on dx used not meeting LCD. As far as I
    know, this is the first denial we have received for this reason. Insurance
    companies are getting more and more difficult to work with and it is so
    frustrating...... 
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