Wiki How To Code Multiple Bursa/Joint Injections

[SLBooker]

Hello All,

I work for a pain management practice and have a question regarding the appropriate way to bill multiple joint injections of same size.
ie...
Patient had 7 toes in total injected, 2 on the RT side and 5 of the LT side - 1st-2nd RT MTP and 1st - 5th LT MTP.
I had previously been advised by a billing lead to only bill 1 injection per side as multiple joints were not reimbursable. I do not agree with this opinion and am reaching out to see how others typically bill multiple joints.

I would bill this as:
20604 50 1st RT/LT MTP
20604 50 2nd RT/LT MTP
20604 59 LT x3 3rd -5th MTP

Of note, I know the way it's billed (multiple line item vs units) will be payor specific. I'm more curious as to whether separate reimbursement for the additional joints injected are covered.

Any advice would be greatly appreciated.

Thanks

 

[Kalisutraj@icloud.com]

I would check the NCCI MUE/MAI table. I believe there is a max of 4 units reportable per DOS for 20604. Also, depending on the injectate you’re using and indication(s) for the injections, be sure to also verify NCD/LCDs for reporting modifiers as well as your payer’s preference in reporting. Many payers (not all) are following CMS guidelines in that respect. For multiple injection reporting, we’ve taken advantage of the narrative to provide a brief description of each injection as you stated above.