Orthopedic Coding Alert

Code 20610 might always need a modifier for Medicare pay. If denials for trigger point and joint injections are plaguing you, sticking to these guidelines will put your injections coding back on the payment track. From California to New Jersey, injection coding dilemmas abound. -What modifier should I use for multiple muscle injections into both knees?- one reader writes. Another reader reports National Government Services (NGS), the Part B carrier for New Jersey, has recently begun denying injection code 20610, stating -required modifier is missing or inconsistent with modifier used.- Avoid these hitches with these 3 quick tips. Report 1 TPI Code per Muscle CPT 2004 revised TPI codes 20552-20553 to have physicians report the codes one time per session, regardless of the number of injections given. The documentation should include the injections- location, number of injections, and muscles involved. According to Catherine Estrada, CCS-P, a coder with Tucson Orthopedic Institute in Ariz., here's how to assign the codes: 1. Use 20552 (Injection[s]; single or multiple trigger points[s], one or two muscle[s]) when the physician injects one or two muscles. 2. When the physician injects three or more muscles, you should report 20553 (... single or multiple trigger point[s], three or more muscles) without units or modifiers. The location of the muscles does not matter. Why: -The narrative description dictates the amount of trigger points per code,- says Jacqui Jones, office manager for an orthopedic physician practice in Klamath Falls, Ore. Also, note that you should follow these rules -no matter the specific anatomical site.- Example: A runner complains of bilateral knee pain (719.46, Pain in joint; lower leg). The doctor injects the popliteus muscles in the back of the right and left knees. In this case, report one unit of 20552. Error averted: You would not use a modifier, such as modifier 50 (Bilateral procedure), to indicate the injection was on each side of the body. Codes 20552 and 20553 are not eligible for bilateral reporting, according to the 2008 Medicare Physician Fee Schedule. Look at Joint Size You-ll choose the correct arthrocentesis code (20600-20610, Arthrocentesis, aspiration and/or injection -) based on the joint size. Use the table on the bottom of this page. Indicate Body Side(s) Joint injection codes, unlike TPI, are billed per injection. Therefore, units and modifiers can come into play, says Connie Treonze, practice manager for Associated Orthopaedics in Union, N.J. The Medicare Physician Fee Schedule allows bilateral reporting with 20600-20610. With knee injections (20610, ... major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]), you might always have to indicate whether the physician performed the injection on the right (RT) side, left (LT) side, or on both knees (bilaterally, modifier 50). NGS [...]