Clarification on 20610/20550

lbpeterson

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I need to ask your help in clarifying this procedure.

Example 1: Pt seen for arthritis in both shoulders, provider decides to perform arthrocentesis of both shoulders.

Do you bill 1. 20610 x 2 units
2. 20610 w/ modifier 50

Example 2: Pt seen for plantar fasciitis in both feet and rotator cuff issue in both shoulders, provider decides to perform injections in both feet and both shoulders.

Do you bill 1. 20550 x 4 units
2. 20550 x 2 units w/ modifier 50

Thanks for any feedback you can give.
 
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btadlock1

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I need to ask your help in clarifying this procedure.

Example 1: Pt seen for arthritis in both shoulders, provider decides to perform arthrocentesis of both shoulders.

Do you bill 1. 20610 x 2 units
2. 20610 w/ modifier 50

Example 2: Pt seen for plantar fasciitis in both feet and rotator cuff issue in both shoulders, provider decides to perform injections in both feet and both shoulders.

Do you bill 1. 20550 x 4 units
2. 20550 x 2 units w/ modifier 50

Thanks for any feedback you can give.
It depends on the payer - some may want you to use the 50 modifier, and some may want separate line items with LT and RT modifiers - it's unlikely that they will accept it with 2 units (or 4).

As for the 4 units - I'd either report it as 20550/LT, 20550/RT, 20550/LT59, 20550/RT59; or 20550/50, 20550/5059, depending on the payer's preference - you'll need to send records, because you will probably get a denial, no matter how you bill it. Hope that helps! ;)
 

mitchellde

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correct me if I am wrong but I do not have my CPT book with me, But doesn't the description of the 20550 state tendon sheath(s)? As in it is a multiple code that can be billed as one line one unit?
 

btadlock1

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correct me if I am wrong but I do not have my CPT book with me, But doesn't the description of the 20550 state tendon sheath(s)? As in it is a multiple code that can be billed as one line one unit?
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Injection(s), single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia")

You're probably thinking of 20552 - Injections(s), single or multiple trigger point(s), 1 or 2 muscle(s)

I thought the same thing when I first read the post... :)
 

mitchellde

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Ah I knew there was an S in there somewhere! I have never had a provider give more than 1 in a setting, I am still curious as to whether you can. But I agree after you look at for a bit it seems so.
 

lbpeterson

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The payer I'm concerned with is Medicare. In the CPT under 20610 there is a (50) icon which says use modifier 50 to report bilateral. This makes me think that you should not be billing 20610 w/ 2 units, but 20610 w/ 50.
 

btadlock1

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The payer I'm concerned with is Medicare. In the CPT under 20610 there is a (50) icon which says use modifier 50 to report bilateral. This makes me think that you should not be billing 20610 w/ 2 units, but 20610 w/ 50.
You are correct - do double your charge amount, though, or you'll be underpaid.
 
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