Question MEDICARE REDUCTION RATE ON 20610

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IF MULTIPLE INJECTIONS ARE GIVEN ON THE SAME DATE OF SERVICE SUCH AS KNEE, HIP, AND SHOULDER) CAN WE BILL THE ADMIN CODE 20610 FOR ALL THREE? ALSO, HOW MUCH WILL MEDICARE REDUCE THE ALLOWABLE PER ADMINISTRATION CODE? PLEASE HELP!
 

ksobota

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20610 x 2, 20610 - 59.

20610 has an MUE of 2 per day, so for the 3rd would need a 59 mod.

Medicare should pay the first at 100%, the second at 50%, and subsequent at 25%
 

thomas7331

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20610 x 2, 20610 - 59.

20610 has an MUE of 2 per day, so for the 3rd would need a 59 mod.

Medicare should pay the first at 100%, the second at 50%, and subsequent at 25%
I think your information is out of date here - Medicare doesn't pay multiple surgeries at 25% any more - it would be 50% for the second and any additional procedures.

The MUE is 2, but in my experience, you cannot usually bypass this edit with a modifier any more, so the third procedure will likely deny, but can be appealed successfully with notes. Also, the Medicare carriers where I've worked do not allow multiple units on surgical codes, so this would be billed on 3 separate lines with one unit each. The second and third will need modifiers, which could be XS or 59 or 76, depending on the Medicare carrier's preference.
 

SharonCollachi

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I do not know if technically, 20610 is an administration code. In my world it is not, it is a procedure code. I look at it this way... it doesn't take a license to give a vaccine, a subcu injection, etc (96372). It takes a license to do a joint injection (20610), a trigger point, etc. One is simply delivery of a medication, the other is an actual medical procedure. So if you look at it that way, how to code multiple procedures, it might be easier.

And it might be easier if you (or whoever is in charge) says look doc, insurance will pay for 2 a day. The rest are free. Do you want to do this in one day or do you want to do lower extremities on one day and upper extremities on another?
 
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