Wiki Multiple Major Joint Injections

jviggiani

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Hello! I am wondering if anyone has had issues with Medicare paying multiple joint injections? I know only two are allowed per session, but my issue is with two different non bilateral body parts. For a right knee and a left shoulder I am coding 20610,RT and 20610,59,LT. Medicare denies it for invalid modifier. I am certain this is their claim editing system but does anyone have any suggestions on how to get these paid the first time around? Thanks everyone !! I appreciate your input.
 
I have just been using right and left. They don't like the 59. But I am for sure going to look into your procedure code 20610. Are you also using the E&M code with modifier? I have just been having problems in general and we have been using the 20553 and I get it denied so going to look into your injection code.

Thanks,
 
I have just been using right and left. They don't like the 59. But I am for sure going to look into your procedure code 20610. Are you also using the E&M code with modifier? I have just been having problems in general and we have been using the 20553 and I get it denied so going to look into your injection code.

Thanks,
20553 is trigger points into a hard knot of muscle, not a joint injection.
 
I have just been using right and left. They don't like the 59. But I am for sure going to look into your procedure code 20610. Are you also using the E&M code with modifier? I have just been having problems in general and we have been using the 20553 and I get it denied so going to look into your injection code.

Thanks,
I tried the 20610,RT and the 20610,LT with respective dx codes and it denies for modifier. We call Medicare and it is very odd they are saying our modifiers are inappropriate. Yes we are using E&M code with a 25. With regard to your 20553, I know that will deny for dx if the dx is not taken from the LCD list of medically necessary dx for a muscle injection. Maybe that could be your issue? Thank you !!!!!!!
 
Hello! I am wondering if anyone has had issues with Medicare paying multiple joint injections? I know only two are allowed per session, but my issue is with two different non bilateral body parts. For a right knee and a left shoulder I am coding 20610,RT and 20610,59,LT. Medicare denies it for invalid modifier. I am certain this is their claim editing system but does anyone have any suggestions on how to get these paid the first time around? Thanks everyone !! I appreciate your input.
I have learned that the RT or LT modifiers are not needed, if your diagnosis code states rt or lt limb then you won't need the modifier LT or RT.
 
Medicare came out with new modifiers that they prefer you use in place of the modifier 59 when appropriate.
CR8863 provides that CMS is establishing the following four new HCPCS modifiers (referred to collectively as X[EPSU] modifiers) to define specific subsets of the 59 modifier:
  • XE Separate Encounter, A Service That Is Distinct Because It Occurred During A Separate Encounter,
  • XS Separate Structure, A Service That Is Distinct Because It Was Performed On A Separate Organ/Structure,
  • XP Separate Practitioner, A Service That Is Distinct Because It Was Performed By A Different Practitioner, and
  • XU Unusual Non-Overlapping Service, The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service.
CMS will continue to recognize the 59 modifier, but notes that CPT instructions state that the 59 modifier should not be used when a more descriptive modifier is available.
 
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