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Bilateral 20610

M

mmoore70

Contributor
Messages
22
Location
Ravenswood, WV
My doc is doing Bilateral injections on knee w/bilateral injection of Depomedrol 80 mg. Do I code 20610-50 and double the charge and code J1040-50 and double the charge. I'm having issues with getting reimbursements billing this way. One insurance company explained that the 20610 already included multiple injections but the only thing that I've come across is if it's for the same joint then you wouldn't bill multiple injections. But these injections are for both right and left knee. Please help.
 
Last edited:
phybilling1 said:
My doc is doing Bilateral injections on knee w/bilateral injection of Depomedrol 80 mg. Do I code 20610-50 and double the charge and code J1040-50 and double the charge. I'm having issues with getting reimbursements billing this way. One insurance company explained that the 20610 already included multiple injections but the only thing that I've come across is if it's for the same joint then you wouldn't bill multiple injections. But these injections are for both right and left knee. Please help.
Click to expand...

Your carrier is incorrect. 20610 has a bilateral payment indicator of "1".

1=Bilateral Surgery (50) 1 = 150% payment adjustment for bilateral procedures applies

20610 is eligible for modifier 50. Modifiers can become carrier specific. Some carriers prefer 50, some prefer LT/RT, some 2 units, etc, etc.

When posting 20610 bilaterally, I post 20610-50 and manually double the fee. Also, many carriers have a local coverage determination for this code. Some carriers follow Medicare's guidance on DX's that warrant medical necessity.
 
phybilling1 said:
My doc is doing Bilateral injections on knee w/bilateral injection of Depomedrol 80 mg. Do I code 20610-50 and double the charge and code J1040-50 and double the charge. I'm having issues with getting reimbursements billing this way. One insurance company explained that the 20610 already included multiple injections but the only thing that I've come across is if it's for the same joint then you wouldn't bill multiple injections. But these injections are for both right and left knee. Please help.
Click to expand...

When I bill this I bill:
20610-RT
20610-LT
J1040 x2 units because I don't think you can put a 50 modifier on a J code.
 
How would you code bilateral shoulder injections along with bilateral knee injections at the same encounter? I am thinking 20610 w/ mod 50 for the first bilateral injections and then maybe 20610 w/ mod XU and modifier 50 for the second set of bilateral injections. Please help
 
mmoore70 said:
My doc is doing Bilateral injections on knee w/bilateral injection of Depomedrol 80 mg. Do I code 20610-50 and double the charge and code J1040-50 and double the charge. I'm having issues with getting reimbursements billing this way. One insurance company explained that the 20610 already included multiple injections but the only thing that I've come across is if it's for the same joint then you wouldn't bill multiple injections. But these injections are for both right and left knee. Please help.
Click to expand...
We have some carriers that want the modifier 50 for a bilateral joint injection, and some that want RT/LT. Either is correct, just depends on carrier. The J1040 is obsolete and has been replaced by J1010 as of April 2024.
 
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