joint size

PLAIDMAN

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I have always used 20605 for a metatarsal/tarsal joint injection, I use 20600 for MPJ and smaller.

Am I wrong in this? I am being denied.

Anyone know where there might be a detailed list of whats what?

thanks!
 

jdemar

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The reference material I refer to is from the 'Ortho Pink Sheet April, 2009, Vol. 10, No. 4 (Ask Margie)' that states in short; refer to the 5th digit of the ICD-9 manual if the 5th digit is a 3 that includes the forearm, radius, ulna, wrist joint; if the 5th digit is a 4 that includes the hand, carpus, metacarpus , phalanges. and likewise the ankle/foot...ie, see page 959 in the 2012 ICD-9-CM (check out the box).
 
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aaron.lucas

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That's because 20605 is only for intermediate size joints, which are described in CPT descriptors (wrist, elbow, ankle, etc.), 20600 is for small joints (eg, fingers and toes), which would definitely include the metatarsal joints, and probably tarsal as well, as they are smaller than the ankle.
 

PLAIDMAN

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sorry

Sorry....I posted question then left town...

It appears no one really knows the answer to that question.

I actually think I figured it out - It was denied stating that there is a more appropriate code choice......the coder used the 20605 w/ dx 726.90 capsulitis.....however the doc did dictate osteoarthritis as well...so I changed dx to that instead of the capsulitis... hopefully that will resolve the issue.

Sorry I dont have a page 959 in my book?
 

jdemar

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sorry, I use AMA Professional Edition, check above diagnosis code 710 and if noted in your book you'll see how the anatomical site relates to the 5th digit or I could fax you a copy of the box I'm referring to.
 
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