Knee injection with imaging guidance

[smarterchild]

Hi all, Wanted to get your input on something.

Recently underwent a Medicare audit for hyaluronic acid gel injections. All of the gel injections were deemed to be medically appropriate but they denied the imaging guidance code, saying it was not "medically necessary". I use either ultrasound (20611) or fluoroscopy (20610 + 77002). My notes had documented that the imaging modality was used to confirm that the gel was placed in the intra-articular space.

Now, when I trained 10 years ago, we did all of our knees under fluoroscopy and I figured that was standard of care. I know some local docs and PCPs just do them blind

I was wondering if any of you guys have encountered this before and if there is any recourse to fight this?

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[RoloTomassi]

You have to have a reason, like obesity, otherwise the "standard" is blind

 

[pastafan]

You have to have a reason, like obesity, otherwise the "standard" is blind

What BS. Fortunately for billing, almost all are obese.

 

[BobBarker]

Man, awful! I do mine with fluoro also. It is just better. Avoid the fat pad and make sure it is in the joint. Should be the standard.

 

[myrandom2003]

My speculation is that the AAOS lobby got image guided removed as standard on this

 

[Doctodd]

Man, awful! I do mine with fluoro also. It is just better. Avoid the fat pad and make sure it is in the joint. Should be the standard.

same here....on all my knees. If you miss with HA and dont get in the space, it hurts for days ALOT and they are reluctant to try any more injections at all.

 

[BobBarker]

Also, visco is very expensive. Shouldn’t we do everything we can to make sure the expensive med gets in the right space???