Orthopedic Coding Alert

Question: I recently received a denial for a cortisone injection to the sinus tarsi with the unlisted-procedure CPT code. Does CPT include a more appropriate code for this procedure?


Montana Subscriber

Answer: The correct code for this procedure is hard to pin down because the sinus tarsi is neither a joint nor a ligament, but a space.
 
Your coding will depend on whether the surgeon administers an injection into the surrounding soft tissue, in which case 20550 (Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar -fascia-]) is appropriate, or if the surgeon injects the actual sinus tarsi space (which is more common).

If the surgeon injects the space itself, you can more accurately describe your work using 20605 (Arthrocentesis, aspiration, and/or injection; intermediate joint or bursa [e.g., temporomandibular, acromioclavicular, wrist, elbow, or ankle, olecranon bursa]).

Your diagnosis will also need to support the appropriate injection code. Surgeons most often use ICD-9 code 726.79 (Enthesopathy of ankle and tarsus; other) to report sinus tarsi syndrome.

Don't forget to use a corresponding J code to gain reimbursement for the drug that the surgeon injected. In the case of cortisone, use J0835 (Injection, cosyntropin, per 0.25 mg).