Orthopedic Coding Alert

You Be the Coder:

Two Injections

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: In one visit, my physician did an injection in both the left shoulder and a finger. Should we code the visit as 20610 and 20550 with a -59 modifier, or as 20610 and 20550 with a -51 modifier?

Arkansas Subscriber

Answer: Because the second injection was at a second site and will have a different diagnosis code associated with it, the carrier should not bundle the two injections, so using the -51 modifier rather than -59 on the second injection is correct. Your codes are correct: 20610 (arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) and 20550-51 (injection, tendon sheath, ligament, trigger points or ganglion cyst, -multiple procedures). The -59 tells payers that you are unbundling a procedure that would normally be bundled, but due to (thoroughly documented) circumstances, the unbundling is justified.

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