united healthcare and cervical epidurals

[smarterchild]

Hi all,

i remember seeing a thread back about how united is no longer covering cervical epidurals with the cervical radiculopathy (m54.12) diagnosis code. I couldn't seem to find it.

Can anyone point me in the right direction or do you happen to know which ICD code will get the cervical epidural (cpt 62321) approved?

thanks in advance

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[Orin]

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/epidural-steroid-injections-spinal-pain.pdf

For some reason they prefer spondy-diagnoses in the cervical region

M43.01 Spondylolysis, occipito-atlanto-axial region
M43.02 Spondylolysis, cervical region
M43.03 Spondylolysis, cervicothoracic region
M43.11 Spondylolisthesis, occipito-atlanto-axial region
M43.12 Spondylolisthesis, cervical region
M43.13 Spondylolisthesis, cervicothoracic region

 

[Multimodal]

they issued a corrected LCD in WA state that again includes the radiculopathy code. sounds like it was either a typo or they got caught trimming the authorized dx codes......the world will never know

 

[painfree23]

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/epidural-steroid-injections-spinal-pain.pdf

For some reason they prefer spondy-diagnoses in the cervical region

M43.01 Spondylolysis, occipito-atlanto-axial region
M43.02 Spondylolysis, cervical region
M43.03 Spondylolysis, cervicothoracic region
M43.11 Spondylolisthesis, occipito-atlanto-axial region
M43.12 Spondylolisthesis, cervical region
M43.13 Spondylolisthesis, cervicothoracic region

Spondylolysis ? How often r you seeing this in the cervical spine

 

[Orin]

they issued a corrected LCD in WA state that again includes the radiculopathy code. sounds like it was either a typo or they got caught trimming the authorized dx codes......the world will never know

That makes so much more sense.

 

[smarterchild]

Thank you so much!!

 

[smarterchild]

Thank you so much!!

 

[clubdeac]

I’m starting to get denials for cervical epidurals at C7-T1. They want the epidurals done at the exact level of pathology. My days of doing C3-4 or C4-5 epidurals are long gone. What a joke

 

[Multimodal]

well maybe a representative from the insurance would like to come by and place a needle in the mid to upper cervical spine where there is little to no "buffer space" in the epidural space. I would argue that with good contrast flow, you would probably see it flowing up around most levels of pathology anyway. fat chance United would go for that argument.

 

[Dr. Ice]

well maybe a representative from the insurance would like to come by and place a needle in the mid to upper cervical spine where there is little to no "buffer space" in the epidural space. I would argue that with good contrast flow, you would probably see it flowing up around most levels of pathology anyway. fat chance United would go for that argument.

Lots of practices going oon with United..not me though, although that would be nice