Wiki 20610 and Post Op Days

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MEDASSURE

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Hi, I just started billing for an Ortho practice. They do a series of 20610 injections on their patients. Once a week for 6 weeks. My question is that 20610 has a global of 10 days but the patients usually come back about 5-7 days after the first injection. They were using modifier 79 but I don't think that is correct because that is saying this injection is unrelated to the first injection which it is not. It's meant to be once a week. Any guidance would be greatly appreciated. I don't want to tank their A/R but I certainly don't want to bill incorrectly to get paid...
 
CPT Code: 20610

Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa)

Intraprocedure services included in the global service package:

1. local infiltration of medication(s), anesthetic, or contrast agent before, during, or at the conclusion of the procedure
2. intraprocedure photo(s) and/or video recording, excluding ionizing radiation
3. intraprocedure supervision and positioning of imaging and/or monitoring equipment by operating surgeon or assistant(s)
4. application of initial dressing, orthosis, continuous passive motion, splint, or cast, including traction, except where specifically excluded from global package

Intraprocedure services not included in the global service package:

1. supplies and medication (eg, code 99070, HCPCS Level II codes)

Medicare global fee period: 0 days
 
I am assuming that your office is providing the patient with viscosupplementation such as Orthovisc, Synvisc, etc as the patient is coming in once a week x 6 weeks.

We bill ours as follows...

Week 1: 20610-LT or RT and J7323(no modifier)

Week 2 through completion: 20610-LT or RT and J7323-EJ

This example is for Euflexxa, but the rules are the same. You do not need an EJ modifier on the HCPCS code for the first injection, however, you will add it to the rest of the series to indicate that it is a subsequent to a series of injections.

This is most likely what is causing you to get a denial stating included in global. Hope this helps!
 
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