Wiki 20610 with 27093

[healing13]

Hi, our pain doc frequently performs arthrocentesis with depo injection and aspiration and joint arthrogram under fluoroscopic guidance in the same session.

The note reads:
Under the guidance of fluoroscopy 3.5 inches G22 was inserted into bilateral hips, then 1cc of IC-Vue was advanced through the needle into bilateral hips, the dye distributed unevenly indicative of severe inflammation, there seemed no evidence of any intra-auricular fractures, then 40 mg of depo-medrol with 2ccs of Marcaine were injected into bilateral hips.

We bill with 27093, 20610 59, and 73525. My doc insists this is correct for what he is doing, however, some of our payers will not allow 20610.
I know there is a CCI on these codes, but he feels the 59 is correctly used.

Is this how it should be billed, and any tips on the payer issue?

 

[dwaldman]

Below from the NCCI policy manual, Chapter 1 General Correct Coding Policies, states this would require a separate encounter on the same day or a separate anatomical site. Due to the fact, CPT 20610 is performed at same anatomical site on the same day as the arthrogram injection 27093, it would not support adding the modifier 59 to CPT 20610.

http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html


One of the common misuses of modifier 59 is related to the portion of the definition of modifier 59 allowing its use to describe ?different procedure or surgery?. The code descriptors of the two codes of a code pair edit usually represent different procedures or surgeries. The edit indicates that the two procedures/surgeries cannot be reported together if performed at the same anatomic site and same patient encounter. The provider cannot use modifier 59 for such an edit based on the two codes being different procedures/surgeries. However, if the two procedures/surgeries are performed at separate anatomic sites or at separate patient encounters on the same date of service, modifier 59 may be appended to indicate that they are different procedures/surgeries on that date of service.


From an NCCI perspective, the definition of different anatomic sites includes different organs, different anatomic regions, or different lesions in the same organ. It does not include treatment of contiguous structures of the same organ. For example, treatment of the nail, nail bed, and adjacent soft tissue constitutes treatment of a single anatomic site. Treatment of posterior segment structures in the ipsilateral eye constitutes treatment of a single anatomic site. Arthroscopic treatment of a shoulder injury in adjoining areas of the ipsilateral shoulder constitutes treatment of a single anatomic site.