Synvisc injection

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upper saddle river,nj
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I'm new to ortho and my provider did an injection (20610) on both the rt and lt knee the patient supplied the drug and the box stated 6ml. Am i billing 12 2 units at 12ml with and the procedure code 20610-rt,lt? Any advice would help?

Thanks
 

Donna T

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Unless I am misunderstanding you - the patient supplied the drug and therefore the only thing you can bill for is the 20610 done bilaterally.
 
Messages
113
Location
upper saddle river,nj
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unless i am misunderstanding you - the patient supplied the drug and therefore the only thing you can bill for is the 20610 done bilaterally.
we have a procedure code that we use for reporting purposes only when the patient provides the drug,but when they don't supply the drug i need to make sure that i'm billing the units and correctly.

Thanks
 

Donna T

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Each syringe of Synvisc is billed using 16 units. If the doctor did bilateral injections then he used 32 units. If you are using Synvisc One then each syringe is equal to 48 units. Does that make sense?
 

cwilson3333

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Synvisc

If the patient supplies the Synvisc, then there should be no need to be concerned with the units. If there are bilateral injections done, I usually bill this way:

20610-RT
20610-59-LT [so the second injection doesn't get the fee reduced, i.e. separate site]

Would like other comments on this mode of billing.

Do any of you bill for the office visit if this is a scheduled injection appointment, say
99211-25??



CW
 

aaron.lucas

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Cherry Hill, NJ
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To cwilson: I would be very careful about doing that. If the payer wants you to bill that way fine, but you really should be doing one line with -50 modifier. Also, whenever using anatomical mods it isn't really appropriate to use -59, as the anatomical modifier defines the different site and takes the place of -59. I would think if this was caught by an audit you may end up paying, but not sure.
 
Messages
113
Location
upper saddle river,nj
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to cwilson: I would be very careful about doing that. If the payer wants you to bill that way fine, but you really should be doing one line with -50 modifier. Also, whenever using anatomical mods it isn't really appropriate to use -59, as the anatomical modifier defines the different site and takes the place of -59. I would think if this was caught by an audit you may end up paying, but not sure.
in the case of the -50 modifier this issue is carrier specific because some want it billed with the modifier and some want the two seperate lines (20610-rt,20610-lt,).
 

cwilson3333

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synvisc

Thanks to my feeback. I usually do RT and LT, and will take your advice and go back to that mode of billing.

CW
 

mitchellde

True Blue
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13,535
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Columbia, MO
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If the patient supplies the Synvisc, then there should be no need to be concerned with the units. If there are bilateral injections done, I usually bill this way:

20610-RT
20610-59-LT [so the second injection doesn't get the fee reduced, i.e. separate site]

Would like other comments on this mode of billing.

Do any of you bill for the office visit if this is a scheduled injection appointment, say
99211-25??



CW
If this is a scheduled injection you are not to bill the office visit, not even a 99211.
 

gmlittle

Networker
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Abingdon, VA
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Can you please direct me to where I can find the documention about not billing an office visit with a Synvisc injection?

Thanks,

Gina CPC, CEMC CPCD
 

mitchellde

True Blue
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Columbia, MO
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Look under the rules for using the 25 modifier. If the reason for the visit was to receive the injection and no other problems expressed by the patient then you will not meet the criteria for significant and separately identifiable
 
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