Q4206 Fluid flow it’s not lab this is flow able allografts derived from human amniotic fluid that aid in tissue regeneration and healing of wounds. One unit of this code represents 1 cc of product used. It is used to treat chronic wounds and soft tissue injury, muscle and meniscus tears, ligament and tendon sprains, degenerative tissue disorders, and Inflammatory conditions such as tendinitis, arthritis and fasciitis. It is administered by injection at the site of injury or disorder. Amniotic fluid is the fluid within the amniotic sac that surrounds the fetus and helps protect it from mechanical injury. Report this code for each 1 cc of the above–described products.
& it can be payable for Medicare too.
Amniotic Tissues and Insurance Coverage
Medicare covers amniotic tissue when used in certain surgeries and for wound care. For example, if a neurosurgeon wants to use a piece of amniotic membrane (the covering of the birth sac) to patch a hole in the dura or an ophthalmologist wants to use some to treat a defect in the cornea, both of those products will usually be covered by Medicare.
Conservative Therapy
It is suggested that the usual 90-days of conservative modalities be employed based on the condition prior to the use of the amniotic injection
For example, in the common case of refractory plantar fasciitis, modalities could include manual therapy, ice massage, stretching, taping, foot orthoses, night splints, iontophoresis, ultrasound, change in footwear, weight loss and cortisone therapy.
If conservative modalities are not effective, consider ordering diagnostic studies to support your diagnosis. MRI and ultrasound can allow accurate localization of the pathologic process and this localization in turn provides an opportunity to deliver a more reliable and focused intervention with the Fluid Flow injection.
Surgical procedures have varying results. One of the goals of amniotic injection is to help avoid the need for surgical intervention
The amniotic injection is low risk, effective and with minimal morbidity and has been shown in Level I studies to be effective in refractory plantar fasciitis. Like with this condition, all other musculoskeletal applications of the injectable Fluid Flow will require documentation of conservative care failure prior to use.
As noted earlier, it is important for the physician to document medical necessity to treat pain and inflammation. As an alternative in treating pain and inflammation, the physician has chosen to utilized Fluid Flow as an injection instead of proscribing a narcotic / opioid.
Document,
If performing Fluid Flow injection #3 or greater to the same structure or area within 6 months, document the medical necessity and justification for this frequency and why treatment is reasonably expected to succeed ◦ Fluid Flow injection at multiple sites, repeated injections, and/or frequent injections may result in a request for medical records, which would need to support the medical necessity of such treatment.
CPT procedure codes for Injections:
| CPT Code | Descriptions |
20550 | Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia") |
20551 | Injection(s); single tendon origin/insertion |
20552 | Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) |
20553 | Injection(s); single or multiple trigger point(s), 3 or more muscles |
20600 | Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance |
20605 | Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance |
20610 | Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance |