Wiki Spine,hip & knee injections

[dyoungberg]

I coded this procedure to Medicare as 64493 rt, 64493 lt, 20610-59 (Bursa) & 20610-59 (Knee). Medicare has denied the 20610 x 2 as being included in the 64493. Here is the Op Note:

PREOPERATIVE DIAGNOSIS: DEGENERATIVE LUMBAR FACET DISEASE, L5-S1, BURSITIS, RIGHT HIP, ARTHRITIS, RIGHT KNEE

POSTOPERATIVE DIAGNOSIS: DEGENERATIVE LUMBAR FACET DISEASE, L5-S1, BURSITIS, RIGHT HIP, ARTHRITIS, RIGHT KNEE

PROCEDURE: 1. C-ARM LOCALIZATION LUMBAR FACETS L5-S1 BILATERALLY
2. INJECTION OF THE LUMBAR FACETS L5-S1 BILATERALLY
3. C-*ARM LOCALIZATION OF THE GREATER TROCHANTER
4. INJECTION OF THE GREATER TROCHANTER BURSA
5. INJECTION, RIGHT KNEE

TECHNIQUE: The patient was placed prone on the operating room table and the lumbar spine was prepped and draped in a routine fashion. The C-arm was used to localized the facet joints at L5-S1 and they were both then injected with a mixture of 8 cc of 1% Xylocaine and 2 cc of Kenalog. The C-arm was used to localize the greater trochanteric bursa and trochanter after a sterile prep, Lidocaine was used to anesthetize the skin and then an injection of 4 cc of 0.5% Marcaine and 1 cc of Kenalog was injected into the trochanteric bursa. Sterile dressing were applied. She was then rolled over and placed supine. The knee was prepped and draped in a routine fashion and then 2 cc of Xylocaine and 1 cc of Kenalog was injected into the knee. Sterile dressing was applied. She was then transferred to the cart and sent to the recovery room.

Can anyone tell me if I was correct in the way I coded this and if so how should I proceed in appealing to Medicare?

Thanks and Happy Friday!

Debbie
Billing Representative
NW FL Surgery Center

 

[mitchellde]

what was the dx codes you used and how were they linked?

 

[dyoungberg]

Hi Debra, I coded 64493 with dx code 721.3, 20610 w 726.5 for the hip and 20610 w 716.96 w knee.