ultra sound denial with Medicare

We sent the appeal with a copy of the ultra sound picture along with all corresponding notes including the surgery notes.

Medicare came back with the following denial:

? The record is lacking documentation that the failure of the initial attempt at the knee joint injection where the provider is unable to aspirate any fluid or that the patients knee size prohibits the providers ability to inject the knee without the ultrasonic guidance.? The description of the knee does not support the need for the ultrasound 76942-R.?

However, they paid the other 2 ultra sound guidance on the same patient which were sent with the same notes.

Help please! Not sure how to proceed from here. Any ideas/suggestions?

Peggy

ultra sound denial with Medicare