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36680 intraosseous injection coded with Total Joint Arthroplasty

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Carol E

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Ortho MD wants to code 36680 for an antibiotic intraossous injection performed at the time of a total joint arthroplasty. Dictation reads, "due to risk of infection, a 15-gauge intraosseous needle was placed into the proximal medial tibial plateau approximately 20 mm below the joint line. This was done just medial to the bottom aspect of the initial incision prior to extending the incision proximally. Once placement into the proximal tibial metaphysis was confirmed, a dilute antibiotic solution was injected into the bone. No complication from the intraosseous needle placement were noted." 36680 is NOT included in the global service package for a total joint arthroplasty, but some coders say this should not be coded separately because it's not medically necessary and standard of care is IV antibiotics, which are included. What are your thoughts, or references, around this?
 
My view is it is included in the surgical package. It is part of the perioperative management. It is done to prevent periprosthetic infection. The reference would be the NCCI Manual or the AAOS GSD. Just because there is no P2P edit, does not mean it can be separately reported. It is an alternative method of abx delivery.
Why wasn't it done IV, was there a reason documented? Was this a revision TKA?
 
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