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Tracy, CPC and Billing

TGETTYS

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I have a scenario I am in need of some assistance. We have a patient that our Doctor did knee joint injection(s) under ultrasound. Dictation states: The patient was in the supine position on the table. We looked at the right knee with ultrasound. We used the ultrasound transducer in the axial plane. We used an in line technique through the transducer and in the superior lateral position injected the medication. We did a sterile prep and drape before the injection,and numbed up with 1% Lidocaine with a 27 gauge 1 and 1/4 inch needle. We then used a 22 gauge, 1 and 1/2 inch needle, and advanced it under real-time visualization of ultrasound into the knee joint. We were able to aspirate about 15ml's of straw-colored fluid, except at the end there was some slight blood tinge in it. We then injected 6ml of 1% Lidocaine and 80mg Depomedrol and pulled the needle out with good hemostasis at the injection site. Before pulling the needle out we did save a picture for the chart. The patient was then placed prone on the table. We used ultrasound to visualize the posterior aspect of the knee, specifically there was found to be a large Baker's cyst. With the transducer in the long axis with respect to the lower limb, we used an in-line technique needle with the transducer to drain the cyst. We did a sterile prep and drape first, and then we used a 27 gauge 1 and 1/4 inch needle through a 3ml syringe to numb up with 1% Lidocaine. We then placed an 18 gauge 1 inch needle under real time visualization with ultrasound into the Baker's cyst. We were able to aspirate about 15ml of fluid. After that, we placed approximately 40mg of Depomedrol alone into the area of the cyst.

I coded and billed this as 2 separate injections for 20611. On the second injection, I did use the 59,51,RT modifiers. I really wasn't sure of billing both but the thought process was Insurance(Medicare) would pay one and deny the other as a duplicate and I was ok with that. Instead they denied both of them as a duplicate. I am really confused which way to go. My options here seem to be do the redetermination request and 1) ask them to remove the second code as billed in error and move on with payment on one or 2) send them the notes for review and ask them to reconsider both of them and if they determine only one is payable then I am ok with that decision. Does anyone have any other suggestions or opinions on how this should have been coded and billed (only one injection) or which is my best option for the appeal
 

Henson65

Networker
Messages
27
Best answers
0
I have a scenario I am in need of some assistance. We have a patient that our Doctor did knee joint injection(s) under ultrasound. Dictation states: The patient was in the supine position on the table. We looked at the right knee with ultrasound. We used the ultrasound transducer in the axial plane. We used an in line technique through the transducer and in the superior lateral position injected the medication. We did a sterile prep and drape before the injection,and numbed up with 1% Lidocaine with a 27 gauge 1 and 1/4 inch needle. We then used a 22 gauge, 1 and 1/2 inch needle, and advanced it under real-time visualization of ultrasound into the knee joint. We were able to aspirate about 15ml's of straw-colored fluid, except at the end there was some slight blood tinge in it. We then injected 6ml of 1% Lidocaine and 80mg Depomedrol and pulled the needle out with good hemostasis at the injection site. Before pulling the needle out we did save a picture for the chart. The patient was then placed prone on the table. We used ultrasound to visualize the posterior aspect of the knee, specifically there was found to be a large Baker's cyst. With the transducer in the long axis with respect to the lower limb, we used an in-line technique needle with the transducer to drain the cyst. We did a sterile prep and drape first, and then we used a 27 gauge 1 and 1/4 inch needle through a 3ml syringe to numb up with 1% Lidocaine. We then placed an 18 gauge 1 inch needle under real time visualization with ultrasound into the Baker's cyst. We were able to aspirate about 15ml of fluid. After that, we placed approximately 40mg of Depomedrol alone into the area of the cyst.

I coded and billed this as 2 separate injections for 20611. On the second injection, I did use the 59,51,RT modifiers. I really wasn't sure of billing both but the thought process was Insurance(Medicare) would pay one and deny the other as a duplicate and I was ok with that. Instead they denied both of them as a duplicate. I am really confused which way to go. My options here seem to be do the redetermination request and 1) ask them to remove the second code as billed in error and move on with payment on one or 2) send them the notes for review and ask them to reconsider both of them and if they determine only one is payable then I am ok with that decision. Does anyone have any other suggestions or opinions on how this should have been coded and billed (only one injection) or which is my best option for the appeal
I'm not sure the description of your second procedure warrants 20611, it does state ultrasound to visualize but doesn't specify it was used for guidance, nor does it refer to permanent recording/reporting for that second procedure. I would be more apt to report 20611-rt and then 20610-59RT....shouldn't use 51 and 59 mod's together
 
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