Joint Injections

[srwiles]

One of my doctors does joint injections of the large joints (20610). He administers J3301, J2001, J0670 (kenallogg, marcaine, and lidocaine) in a premixed solution. The Medicare appeals line told our office that we should be adding a 59 modifier to the J2001 (lidocaine) for it to be paid. However it is all part of the same injection. Does anyone know how this can be correct?

Thank you

[thompsonsyl]

Hi,

I thought your question was really interesting. I didn't realize that a modifier -59 could be used on J codes. I looked up cpt 20610 on the CCI Edits and it does list J2001 as a component code, however, the modifier indicator is (1) so a -59 is allowed to unbundle it.

My thinking is that since the injection site has to be anesthetized with the lidocaine in order to perform the arthrocentesis, it is considered "included". By adding the -59 modifier, you are telling Medicare that there is some reason why you are unbundling the lidocaine from the arthrocentesis being done. Does your MD use lidocaine for other than blocking the injection site?

Hope this helps & thanks for helping me to learn something new from your question!

[safnlp]

if you look up in the hcpcs you can not bill for lidocaine any more it is bundled in to the procedure

[Catherine.]

The marcaine and lidocaine and kenalog are for pain relief and are not to be reported seperately when administered with another drug. (such as cortisone, synvisc etc.)

[Lisa Bledsoe]

The kenalog is billable, but not the marcaine/lidocaine. If you read the description for J2001 it is for INTRAVENOUS infusion.

[Trendale]

Originally Posted by Lisa Curtis

The kenalog is billable, but not the marcaine/lidocaine. If you read the description for J2001 it is for INTRAVENOUS infusion.

In regards to 20610 and J2001, is it appropriate to bill this with an E/M visit and should a modifier 25 be attached or would the injection be included in the E/M visit?

[RebeccaWoodward*]

This is a hot topic in our office. IMHO, I see no problem billing an e/m code if the physician assess' the patients complaint and with his medical decision making, decides to perform a joint injection. Now...if the physician offers the joint injection and the patient wants to "think about it" and comes in a week later for the injection, no, don't bill an e/m (again) with the joint injection. I feel that that the physician already provided the medical decision making for the e/m in the previous visit...therefore, only bill the joint injection with the kenalog. Medicare also told our office to apply the modifier 59 to the lidocaine injection, which was incorrect! Hope this helps~

[Lisa Bledsoe]

You can only bill the E/M with mod -25 if there is a significant separatey identifiable E/M from the reason for the joint injection. J2001 cannot be billed as it is for intravenous injection.

[kandigrl79]

I agree with Lisa, up until two weeks ago, I worked for a very large ortho practice and you cannot bill for the lidocaine, you should bill the joint injection (20610) with the kenalog (j3301) and that's it. As far as the modifier 25 even if the doctor did the medical decision making for the e/m and the patient agreed to the injection, you cannot bill the e/m unless you evaluated the pt. for some other problem (hence modifier 25 which stipulates separately identifiable e/m service). Say for example the pt. presents complaining of knee pain and wrist pain, the doc. may decide to inject the knee and just watch the wrist, well in that case you could bill the e/m with modifier 25, but if the pt. simply presented with knee pain and the doc. decided to do a knee injection, you could only bill the injection and the drugs.

[nikkisgranny]

The use of when to use or when not to use -25 has me confused. The more I try to understand it the worse it becomes. Working in an ortho office, we, of course, do injections all day long.

New patients: Bill an E/M with a -25?

Established patient: New problem of knee pain; doctor suggests getting an injection (20610) to help calm the symptoms-bill E/M with -25 or just bill the procedure? What if they are following up on a current knee issue and the doctor suggests trying an injection for theraputic reasons?