Orthopedic Coding Alert

Question: For Synvisc/Hyalgan injections, we usually have to order the medication after precertifying the patients. If the physician has already determined that the patient would benefit from these injections, we do not bill an E/M with the first injection.  Is this correct?

Wyoming Subscriber

 
Answer: Yes, you are correct. Because these encounters are scheduled for the expressed purpose of performing the injection, only 20610 (Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) and HCPCS code J7320 (Hylan G-F 20, 16 mg, for intra-articular injection) should be reported. It would be appropriate to report an E/M code with these codes if a separate service was rendered for an unrelated condition.