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Wiki 20611

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drbarnes

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When Billing Multiple injections for Medicare w/ 20611 X 3
J1010

Dx Code-M7061

Is their a modifier or something specific needed in order to get all 3 injections covered?
 
The diagnosis code you have there is RT hip trochanteric bursitis. Why would 3 major joint injections with US be done for a single joint?
We would need more information to understand your question. Are they performing major joint injections on bilateral hips and one knee or one shoulder for example? If so, you would need to assign the correct diagnosis and laterality to each injection for starters. If it is bilateral say, in both hips one line would have a modifier 50 on it for the hips. If there was an additional like the knee or shoulder you would do a second line with that.

Links below are couple other discussions on it. Some payers won't allow 3 at the same time. Some will. Coding can vary depending on health plan.


Example of a MAC discussion on bilateral indicators, this one is good because it has joint injections as the example.

Noridian had a video about it but it's older and may not apply nowadays.
 
amyjph said:
The diagnosis code you have there is RT hip trochanteric bursitis. Why would 3 major joint injections with US be done for a single joint?
We would need more information to understand your question. Are they performing major joint injections on bilateral hips and one knee or one shoulder for example? If so, you would need to assign the correct diagnosis and laterality to each injection for starters. If it is bilateral say, in both hips one line would have a modifier 50 on it for the hips. If there was an additional like the knee or shoulder you would do a second line with that.

Links below are couple other discussions on it. Some payers won't allow 3 at the same time. Some will. Coding can vary depending on health plan.


Example of a MAC discussion on bilateral indicators, this one is good because it has joint injections as the example.

Noridian had a video about it but it's older and may not apply nowadays.
Click to expand...
Thank you for a response. We have similar information but can't make sense of it.
 
What is the misunderstanding or can't be made sense of? Are you just reviewing charge line items and the documentation doesn't support it? Is it an error? Did the note state both aspiration and injection and someone thinks they can bill 20610 or 20611 2x for the same joint (which you can't)? I have seen this error with new folks.

If the provider performed and properly documented three separate major joint injections w/ US you would see 3 different diagnoses or possibly two if one of them was bilateral knee OA for example.

For example, if the provider performed bilateral knee injections and the RT hip it might look like this:
20611-50 with 1 unit and double fee with dx M17.0 (if it was for knee OA for example)
20611-RT with 1 unit M70.61 (if it was for trochanteric bursitis RT hip)
J codes used w/ correct units

The modifier 50 is for paired organs such as hip, knee and shoulder. You are telling the payer it was done on both sides.
The second line with RT shows it was RT side only.
The diagnoses have to make sense with the line item billed.
As always, the documentation must support all of this.

Again, some plans may not allow more than 2 in one day. I have not seen a lot of 3x in one day done over the years. That seems like a lot.
 
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