Orthopedic Coding Alert

Question: Should we report 64450* (Injection, anesthetic agent; other peripheral nerve or branch) or 20605* (Arthrocentesis, aspiration and/or injection; intermediate joint or bursa [e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa]) when the orthopedist administers a medial epicondyle injection to a patient with medial epicondyli-tis (726.31)? Minnesota Subscriber Answer: Based on your description, you should report 20605. According to the Medicare Carriers Manual (MCM), 20605 involves the following: "After administering a local anesthetic, the physician inserts a needle through the skin and into a joint, bursa or ganglion cyst. A fluid sample may be removed from the joint, or a fluid may be injected for lavage or drug therapy. The needle is withdrawn and pressure applied to stop any bleeding."

The MCM's description of 64450 states, "The physician anesthetizes a nerve to provide pain control or blockage. This code is used only when no other procedure is applicable."

The physician's wording in the documentation is key when determining whether to report 20605. If the documentation is unclear, ask the physician which code is appropriate.