Results 1 to 8 of 8

Modifier 53 on Knee Injection

  1. #1
    Default Modifier 53 on Knee Injection
    Exam Training Packages
    Would modifier 53 be appropriate for a knee injection that was discontinued after two attempts (but after local anesthetic was given)? This is for a physician's office. Thanks.

  2. #2
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    Mary, CPC, CANPC, COSC

  3. #3
    Default
    Thank you for the info. Are you thinking the 53 would not be used in this case because of why the procedure was discontinued - since it was unsuccessful versus threatening the well being of the patient?

    The CPT code being used is 20610. Maybe modifier 52 would be better or possibly this should not be billed at all.

    Thank you.

  4. Default
    First I would say to review the documentation and determine why the injection didn't end up happening (why it was 'unsuccessful'). There's multiple reasons why that may be, and that rationale may lead us to the correct answer for this one. Can you send that information back through?

    Kris

  5. #5
    Default
    The physician did not elaborate on why, just documented two failed attempts and that it was not accomplished. Local anesthetic was given. This was an euflexxa injection.

    Thanks.

  6. #6
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    52 sounds to be the more appropriate modifier for your scenario
    Mary, CPC, CANPC, COSC

  7. Default
    Okay, well if you think that if you gave the insurance carrier what the physician wrote about the failed attempts that they would make payment, then perhaps you don't need to make an additional query or ask for further documentation. In that case, simply "failed attempts", then modifier 52 would seem to best fit the situation. In the local use text field of the claim enter "Documentation Available Upon Request", and reduce the charge to what would be appropriate for the provider's work that day.

    But if you question it at all, then I would recommend making at least an attempt, letting your provider know that you want to be sure that if the carrier asks for the documentation, you will be certain that what is there will support him/her getting payment for the attempts.

    Not sure if this will help, but WPS Medicare Part B, for Michigan, has a modifier 52 fact sheet that can be found at:

    http://www.wpsmedicare.com/part_b/ed...odifier_52.pdf

    Kris

  8. #8
    Default
    Provider has been queried and am waiting response (provider was out for conference). It's a great help to have it narrowed down to 52 or 53 so will be informed when I hear back from him.

    Thank you so much for your help!

Similar Threads

  1. knee injection help
    By Kathy615 in forum Orthopaedics
    Replies: 2
    Last Post: 07-22-2015, 08:51 AM
  2. Injection-Knee
    By svms in forum Orthopaedics
    Replies: 2
    Last Post: 05-19-2014, 07:31 AM
  3. Total knee and did an injection
    By mrsroski in forum Orthopaedics
    Replies: 1
    Last Post: 05-31-2013, 09:31 AM
  4. injection inferolateral aspect knee
    By WonderCoder in forum Orthopaedics
    Replies: 1
    Last Post: 07-24-2012, 12:25 AM
  5. knee injection
    By cbunti in forum Orthopaedics
    Replies: 6
    Last Post: 12-02-2010, 12:02 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.