Lateral Epicondyle Injection w/Ultrasound Guidance

lcole7465

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My doctor performed a lateral epicondyle injection. He was told by an Ortho provider that the code should be 20605/20606. Everything I'm finding is pointing towards 20551.

The Report reads: "The patient was placed in the supine position with the affected limb, with the shoulder in abduction and internal rotation, and the elbow flexed. We therefore, cleaned the radial aspect of the right elbow with chlorhexidine in the usual sterile fashion. We identified the right lateral epicondyle under ultrasound guidance. we advanced the 27-gauge needle. There was positive activation of the ulnar hypothenar muscle of the hand with the Stimuplex needle in place. Then had a negative aspiration and injected a total of 4 mL of lidocaine 1 %, as well as 40 mg of Depo-Medrol. Needle was removed. Dressing was applied."

If anyone has any guidance on this, it would be greatly appreciated.
 

thomas7331

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This isn't my specialty area, but I think you are correct - 20605/20606 would be use for an injection into the joint itself, but the lateral epicondyle is external to the joint capsule, so 20551 would be appropriate. Do you have a diagnosis? Injections into the joint are more often for arthritis, bursitis or joint pain, whereas 20551 I would expect for treating something like tendonitis or epicondylitis/tennis elbow. Or you may wish to query the provider as to whether or not the needle was actually placed inside the joint for the injection, since the documentation isn't completely clear on this.
 
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dwaldman

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Tennis elbow, also known as lateral epicondylitis,

"The physician injects a therapeutic agent into a single tendon sheath, or ligament, aponeurosis such as the plantar fascia in 20550 and into a single tendon origin/insertion site in 20551"

The procedure note would have to describe the needle final destination was at a tendon origin/insertion to support billing 20551. If the documentation is describing a tendon sheath being injected or it not fully clear that the needle was at the tendon origin/insertion then 20550 is reported. 20605-20606 is for injecting the elbow joint, if the joint is not being injected then it has to be 20550 or 20551 depending on the tendon origin/insertion being documented or not.

Below is from Supercoder describing a tennis elbow injection, I don't have a CPT book in front of me but I remember it saying for a tennis elbow injection to report 20550

https://www.supercoder.com/coding-newsletters/my-orthopedic-coding-alert/reader-questions-20550-or-20551-for-elbow-epicondylitis-injection-article


Question: What is the best code for an injection to treat elbow epicondylitis? Missouri Subscriber

Answer: When your physician does this procedure, she generally is injecting the insertion, which is 20551 (Injection; single tendon origin/insertion). However, CPT's section on elbow introduction or removal includes the notation, "for injection of tennis elbow, use CPT 20550" (Injection, single tendon sheath, or ligament, aponeurosis [e.g., plantar "fascia"]). Code 20551 might be the best choice in many cases, but check your physician's documentation to be sure you shouldn't be reporting 20550 or another code instead. Don't slip: Coders sometimes turn to 20605 (Arthrocentesis, aspiration and/or injection; intermediate joint or bursa [e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa]) for tennis elbow, but 20550 is the better choice.
 
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