decisionhealth Newsletters, Part B News - 2019 Issue 2 (February)
Look to code description to determine correct units for problematic injections
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Article Overview
This article discusses a common coding problem affecting pain and orthopedic injection claims, with emphasis on HCPCS reporting, Medicare review activity, and the importance of reading code narratives carefully. It is aimed at coders, billers, and practices that submit injectable drug claims and want to understand why some claims are being rejected and what categories of documentation and billing guidance are involved.
Why This Topic Matters
Incorrect unit reporting can lead to denials and repeated claim errors for commonly billed injections. The article helps readers recognize that unit reporting depends on the HCPCS narrative and that Medicare contractors may scrutinize these claims.
Article Sections
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Coding
Overview of the billing issue, including the claim denial trend and the Medicare contractor attention prompting review of these injection claims.
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Resources
Reference materials and external guidance cited for further review of the reporting issue.
What You Will Learn
- Why some injectable drug claims are being denied or corrected
- How HCPCS narrative wording affects unit reporting
- What types of Medicare guidance are referenced in connection with the issue
- Why documentation of administered quantity is emphasized in the article
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Pain management practices
- Orthopedic practices
- Medicare providers
Codes Discussed
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Quick, Current, Complete - www.findacode.com