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Maximum units on 20550

  1. Default Maximum units on 20550
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    Not sure if this has been addressed before but, does anyone have the official information from the NCCI on maximum units allowable on CPT 20550?

    Thanks!

  2. #2
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    I don't see it addressed on the NCCI edits...The "Medically Unlikely Edits" doesn't provide a max unit-Under downloads...look in the excel spreedsheet "Practitioner/DME Supplier MUE Table"...

    http://www.cms.hhs.gov/NationalCorre....asp#TopOfPage

    However---Per the AMA...Code 20550 should be reported one time for multiple or single injections to a single tendon sheath, ligament, tendon origin, or tendon insertion performed. Therefore, if three injections are performed into the same tendon sheath, code 20550 should be reported one time. Injections to multiple tendon sheaths, tendon origins, tendon insertion, or ligaments are reported one time for each injection

  3. Default
    I do not think that CPT code 20550 is addressed in Medicare's Medically Unlikely edits (as published or non published MUE);there appears to be no maximum allowable units set.

    The descriptor indicates "Injection(s); single tendon sheath, or ligament, apneurosis

    It appears that the units should reflect the number of tendons sheaths, ligaments...injected; not the number of injections.

    Hope this helps,
    Anthony McCallum, CPC, CIRCC, CPC-I, CCS
    ciphermed@optonline.net

  4. #4
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    Multiple injections to the same tendon sheaths, tendon origins, tendon insertion, or ligaments would be reported one time only, while injections to multiple tendon sheaths, tendon origins, tendon insertion, or ligaments are reported one time for each injection.

    CPT Assistants:

    August 2003 / Volume 13, Issue 08

    -and-

    September 2003 / Volume 13, Issue 09

  5. Default
    There is no publication regarding the number of units. The only way to find out is to write to the NCCI and they will provide the info. Thought maybe someone had done so. It is multiple locations and most payers will allow. It's just Medicare and the NCCI rules. They allow for multiples just won't provide the information as to how many can be performed. Just say charge for what you are doing, then they will either pay or deny if it falls within the limits and IT is one of the few that is not published in any source.

    Redetermination can be requested.

  6. #6
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    Columbia, MO
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    20550 states injection(s) single tendon. so what Rebecca stated is correct. You cannot use units greater than 1 with this code becuse the descriptor of the code already indicates multiples. If you inject different tendon sheaths then you bill multiple line items using the 59 modifier to indicate distinc and separate tendon sheath.

    Debra A. Mitchell, MSPH, CPC-H

  7. Default
    I understand how to code it. I code it all the time, for rheumatology and pain management.
    The dilemma is, MEDICARE per the NCCI guidelines, limits the number of units even though it is different tendons.
    They will not verbalize how many units I can bill i.e. how many different sites can be done.
    I contacted them. They did say more than one is allowable. We bill two and 3 units all the time. However the # we billed on a patient was not allowed, yet they indicated I could have billed more than one unit.

    Unfortunately just how many units (different locations and injections) we can bill is not for public consumption like other #s of units on other codes may be.

    The only way I can get the information is to write and request it from NCCI. I will do so and when I get the information I can let everyone who wants to know, know that.
    I was just hopeful that someone else had already written to them. Maybe I didn't ask the question in a way that was clear.

    Thanks.

  8. #8
    Location
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    But are you assigning units or billing separate line items with a 59 modifier. 20550 cannot be billed with units greater than 1.

    Debra A. Mitchell, MSPH, CPC-H

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