It will depend on the insurance how to code the bilateral joint injection. Medicare likes 20610-50 x1 unit and charge 150% of the fee; others like two line items 20610 (100% of the fee) and 20610-50 (50%). You do need mod -25 on the e/m as you have it listed and yes, you should charge for the kenalog. We usually code J3301 x4 for one large joint, so you probably have J3301 x8.
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