Modifier Coding Alert
Coding Injections With Fluoroscopy
PDF
Question: Our physician recently performed multiple arthroscopic injections, and the encounter notes look kind of tricky. Documentation indicates that the physician performed injections on the patient’s left finger and right elbow. Further, the notes state that the physician used fluoroscopic guidance for both of the injections. The only codes I see that specify guidance are for ultrasounds. How do I code for intra-articular injections with fluoroscopic guidance?
Nevada Subscriber
Answer: On the claim, you should report 20605 (Arthrocentesis, aspiration and/or injection, intermediate joint or bursa [e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa]; without ultrasound guidance) for the elbow injection with modifier RT (Right side) appended. Then, report 20600 (… small joint or bursa [e.g., fingers, toes]; without ultrasound guidance) for the finger injection with modifier LT (Left side) appended.
Finally, report 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) times two for the guidance. Ensuring that the documentation clearly show that the injection sites were two separate locations is important, as this will prove that reporting the fluoroscopy code twice was correct coding. You may also want to check with your payer to see if it wants modifier XS (Separate structure) or modifier 59 (Distinct procedural service) appended to the fluoroscopy codes to better illustrate this point. Using 59 or XS will depend on your payer.
Related Articles
Modifier Coding Alert
- Modifier Madness:
Sort Out Modifier Mess On Multi-Provider Fracture Care
When you divide fracture claims, providers engage in a 70/30 split. Let’s face it: When [...] - E/M Modifiers:
Let Payer Policy Guide Your Pre-Fracture Care E/M Decision
Both 25, 57 are in play with E/M-fracture code combo. When your physician provides intraoperative [...] - Specialty Focus:
Gastroenterology: Be Ready With Modifier Knowledge When Screenings Turn Therapeutic
Medicare, CPT® offer different guidance on modifier choices. When your gastroenterologist performs a screening flexible [...] - You Be the Coder:
Coding Injections With Fluoroscopy
Question: Our physician recently performed multiple arthroscopic injections, and the encounter notes look kind of [...] - Reader Questions:
Back Up CMT Claims With AT Modifier
Question: Our chiropractor provided chiropractic manipulative treatment (CMT) on three regions of an established Medicare patient’s [...] - Reader Questions:
Dig Deep Into Training With These ICD-10 Tips
Question: The closer we get to the ICD-10 implementation date, the more antsy employees at our [...] - Reader Questions:
Break Out 25 When Counseling Leads To Vaccination
Question: An established 19-year-old patient reported to our family physician for counseling on administration of the [...] - Reader Questions:
Mind Modifiers When Coding I&D Repeats
Question: A new patient recently reported to our practice complaining of a cyst that was leaking [...] - Reader Questions:
Make Modifier a Part of Multi-Shot Claims
Question: A 36-year-old new patient reports to the physician complaining of a headache and severe fatigue. [...]