briansmith99
Networker
I've been trying to figure out how to avoid rejections from payers who assume that joint injections always come with a laterality modifier. What advice do we have for injections that are strictly mainline? Sacrococcygeal joints are not bilateral and they are not on either side of the body, they are midline. Billing 20605 with no modifier seems to cause payer rejections but what other options are there?
Example note -
Patient was brought to the operating room and placed on the procedure table in the prone position. The area overlying the sacrococcygeal joint was then prepped with chlorhexidine scrub followed by sterile drapes. Palpation identified the point of maximum tenderness over the distal sacrum/coccyx. With the use of fluoroscopic guidance for needle placement, the skin and subcutaneous tissue was anesthetized using a 27-gauge needle and 1 mL 1% lidocaine. Following this, a 25-gauge 1-1/2 inch needle was then advanced into the sacrococcygeal joint under lateral fluoroscopic guidance. After negative aspiration, 0.1 mL radiopaque contrast was injected into the sacrococcygeal joint, showing good spread throughout the joint without vascular uptake or creating paresthesia. Then, again after negative aspiration 2 mL injectate was slowly injected into the sacrococcygeal joint and surrounding ligamentous tissue. The needle was then removed, and a bandage placed over the injection site. Injectate consisted of 4 mg dexamethasone (4 mg/mL) combined with 1 mL 0.25% Marcaine. Blood loss was minimal.
Example note -
Patient was brought to the operating room and placed on the procedure table in the prone position. The area overlying the sacrococcygeal joint was then prepped with chlorhexidine scrub followed by sterile drapes. Palpation identified the point of maximum tenderness over the distal sacrum/coccyx. With the use of fluoroscopic guidance for needle placement, the skin and subcutaneous tissue was anesthetized using a 27-gauge needle and 1 mL 1% lidocaine. Following this, a 25-gauge 1-1/2 inch needle was then advanced into the sacrococcygeal joint under lateral fluoroscopic guidance. After negative aspiration, 0.1 mL radiopaque contrast was injected into the sacrococcygeal joint, showing good spread throughout the joint without vascular uptake or creating paresthesia. Then, again after negative aspiration 2 mL injectate was slowly injected into the sacrococcygeal joint and surrounding ligamentous tissue. The needle was then removed, and a bandage placed over the injection site. Injectate consisted of 4 mg dexamethasone (4 mg/mL) combined with 1 mL 0.25% Marcaine. Blood loss was minimal.