Insurrance won’t cover TPI

[deleted875186]

One of the local states BCBS won’t cover TPIs. Non covered service.

Can I simply bill an office visit, talk to the patient, do a TPI and not bill the 20553? Is this insurrance fraud to purposefully not bill for a service offered.

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[buddababa]

One of the local states BCBS won’t cover TPIs. Non covered service.

Can I simply bill an office visit, talk to the patient, do a TPI and not bill the 20553? Is this insurrance fraud to purposefully not bill for a service offeri

if its a non - covered service, or insurance denies it, technically you can do what you want, but you cant just bill an office visit in lieu of not billing a TPI so you can get paid. Instead, have them come in for an office visit, and do what you do for an office visit and explain, etc and then if you decide to do an injection for free, then that's up to you.

 

[Pain Applicant1]

Which BCBS plan is this? Try 20552 and see if that works. Agree with the poster above.

 

[Ducttape]

some insurances are requiring also that you specify which muscles you are targetting and will deny if you dont specify them.

 

[deleted875186]

BCBS Rhode Island, I’m told it doesn’t cover any TPIs, which seems insane

 

[Ducttape]

technically, i know we get paid more for a level 4 follow up visit than a tpi, for whatever thats worth...

 

[Laryngospasm]

Tpi is hardy worth the trouble.. I think I get half an rvu for it or so. But I do them when needed. Just another disservice to the patients. This game is getting more and more one sided.

 

[deleted875186]

if its a non - covered service, or insurance denies it, technically you can do what you want, but you cant just bill an office visit in lieu of not billing a TPI so you can get paid. Instead, have them come in for an office visit, and do what you do for an office visit and explain, etc and then if you decide to do an injection for free, then that's up to you.

Yes, I was planning on doing a follow up, exam, discussing stuff, my question is can I do a TPI at the end and bill a 99213, document a TPI, but not bill a 20553?

 

[bedrock]

Yes, I was planning on doing a follow up, exam, discussing stuff, my question is can I do a TPI at the end and bill a 99213, document a TPI, but not bill a 20553?

if youre doing a TPI for free, I would definitely bill a 99214

 

[drusso]

One of the local states BCBS won’t cover TPIs. Non covered service.

Can I simply bill an office visit, talk to the patient, do a TPI and not bill the 20553? Is this insurrance fraud to purposefully not bill for a service offered.

We offer it for cash.

 

[Pain Applicant1]

Yes, I was planning on doing a follow up, exam, discussing stuff, my question is can I do a TPI at the end and bill a 99213, document a TPI, but not bill a 20553?

I think technically you have to document everything you do and you have to bill everything you document. It probably won't make a difference either way but you can consider billing the office visit, using a modifier 25, and then billing the TPI. Let the TPI get denied as a non-covered service. Make sure you have notes to document both.

 

[Ferrismonk]

BCBS Rhode Island, I’m told it doesn’t cover any TPIs, which seems insane

Do they cover acupuncture?

Most patients that I see that need trigger points also have other pathology. I'll treat the facets/etc and just do the TPI for free during the procedure. It's basically extra local to the skin/muscles which you are doing anyway...

 

[deleted875186]

I think technically you have to document everything you do and you have to bill everything you document. It probably won't make a difference either way but you can consider billing the office visit, using a modifier 25, and then billing the TPI. Let the TPI get denied as a non-covered service. Make sure you have notes to document both.

I thought about this, but I work for a hosptial and assumed the hosptial would send the patient a big bill.

 

[deleted875186]

Do they cover acupuncture?

Most patients that I see that need trigger points also have other pathology. I'll treat the facets/etc and just do the TPI for free during the procedure. It's basically extra local to the skin/muscles which you are doing anyway...

Yes I do this as well, this was a young patient with back pain, trying not to inject the facet joints or anything.

 

[DODOCSS]

sounds like a 20551 to me

 

[Pain Applicant1]

I thought about this, but I work for a hosptial and assumed the hosptial would send the patient a big bill.

I'm not sure that your assumption would be correct. Typically, if the insurance denies a code you cannot bill the patient. The claim just gets denied. They don't transfer the charge to the pt. If they approve it then it will get processed and be paid for or be incorporated into the pt deductible, co-insurance, co-pay, etc.

As an aside, they love denying claims and will do everything possible to make this happen. Prior auths, span dates, non-covered services, etc are some strategies they employ. Even if you receive an approval code, it doesn't guarantee that the code is approved and will be paid for. Go figure that one out.