Orthopedic Coding Alert

Question: Is there a set of rules as to how many injections can be billed at the same time? Do I need a -50 or -51 modifier? Plus, how many J codes can be billed simultaneously?

Minnesota Subscriber

Answer: Code 20550 (injection, tendon sheath, ligament, trigger points or ganglion cyst) and the joint aspiration/injection codes, 20600-20610, can be billed multiple times. Most commercial carriers and Medicare will accept multiple injections with modifier -59 (distinct procedural service) provided the injections were at different sites and the ICD-9 codes support medical necessity.

Each injection code should be billed on a separate line, with modifier -59 after the second, third code, etc. Several carriers do not recognize modifier -50 (bilateral procedure), and for injections there is no benefit to using this modifier (if, for instance, an injection was done in both knees). Use of the -51 modifier for multiple procedures will result in an immediate reduction of your fee, and again is not necessary with injection codes.