Wiki Lumbar interspinous bursa injection

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SheilaG65

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What CPT would you use for an ultrasound-guided lumbar interspinous bursa injection? 20550 has been used in the past but I'm not convinced that's correct. When I go to the CMS website and look it up I don't see any diagnosis codes pertaining to the spine, they are all for issues with hips, shoulders, knees, etc. Thanks!
 
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When I run this through my encoder I'm getting 20611 (Arthrocentesis, aspiration, and/or injection, major joint or bursa; with ultrasound guidance). I would consider the spinal injection to be major and not moderate.
 
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Did you check CPT Asst to see if there's any guidance? Seems like it would be 20611 but I haven't done one in so long I can't remember. 20550 does not seem correct.
 
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Was there a device placed? Can you provide a little more information on the procedure itself? I'm finding some more information, but is may be conflicting depending on the specific procedure.

amyjph said:
Did you check CPT Asst to see if there's any guidance? Seems like it would be 20611 but I haven't done one in so long I can't remember. 20550 does not seem correct.
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jkyles@decisionhealth.com said:
Hi there, can you provide an op note?
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Procedure note: A prone position was used with a right paramedian approach to the bursae. The sacrum, L5, L4, L3 and L2 spinous processes were identified in the midline using a sagittal US view. The L2-3, L3-4, L4-5, and L5-S1 interspinous spaces were identified. Each of these were tender on exam. He was nontender at the L1-2 interspace. Bursitis was evident on ultrasound particularly at the L4-5 and L2-3 levels. Proper target depth was identified. The skin was prepped with Hibiclens and sterile ultrasound gel, probe cover and gloves are used. Vapocoolant spray anesthetized the skin followed by alcohol prep. A 21-gage 2 inch needle was then directed under ultrasound guidance into each interspinous space, using a step down short axis technique and visualizing the needle tip enter the bursae. Into each I injected 0.75 cc of a mixture of 2 cc of Kenalog 40 mg/mL and 3 cc of lidocaine 2%. The patient tolerated this well.
 
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Here are some follow-up questions from the doctor:
I injected 4 different spinal bursae (4 levels in the same region). It took me 20 minutes. This time I billed 1 bursa, but should I bill it 4 times? And thinking it through, it's probably a "medium" bursae, not small.
What do you think, bursa or ligament, and 1 vs 4?

I appreciate everyone's help, this is not my area of expertise!
 
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Thanks, I agree that a joint/bursa code makes sense based on the codes' descriptors. You will need to ask the doctor to determine whether 20604 (minor), 20606 (intermediate) or 20611 (major) is appropriate.

It is appropriate to report more than one injection, but the doctor should clearly state how many bursa(e) they injected.
 
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After researching again, I think moderate bursa would be appropriate. I would report this 4 times for the 4 separate locations and you'll most likely have to append modifier XS to 3 of them.
 
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