Anesthesia Coding Alert

Question: What diagnosis should I submit to support Synvisc administration? 


Rhode Island Subscriber
  

Answer: Diagnosis coding possibilities include 715.3x (Osteoarthrosis, localized, not specified whether primary or secondary), 715.90 (Osteoarthrosis, unspecified whether generalized or localized; site unspecified) or osteoarthritis (such as 721.90, Spondylosis of unspecified site; without mention of myelopathy).
 
Your carrier's policy might allow for other diagnoses, so check your local guidelines. Be sure your physician's documentation supports the diagnosis you submit.

Procedure codes: When reporting the procedure, submit either 20610 (Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) or 27599 (Unlisted procedure, femur or knee).

If your physician administers the Synvisc during a separately identifiable office visit, append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code (such as 99203, Office or other outpatient visit for the evaluation and management of a new patient ...).

Bilateral check: Then verify whether your physician administered bilateral injections. If so, append the appropriate modifier to the procedure code, depending on your carrier's preference for bilateral reporting. Choices include modifier 50 (Bilateral procedure) or modifiers LT (Left side) and RT (Right side).

Precert note: Work with the carrier to obtain precertification for the procedure. Remember that completing precertification can take up to two months, so be sure your patient realizes this and is prepared to pay for the Synvisc injection herself if her carrier does not reimburse. Have the patient sign an advance beneficiary notice ahead of time if she'll be paying for the injection herself.