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Thread: modifiers on joint injections when billing MCR

  1. #1

    Exclamation modifiers on joint injections when billing MCR

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    I have a pt that had multiple joint injection to the left and right side of the ankle. We billed it as following
    20600-LT
    20600-RT/51
    20600-LT
    20600-RT/51

    Should we have billed it as
    20600-RT/LT/50
    20600-RT/LT/51

    Please help MCR has denied clm.

    Thanks

  2. #2
    Join Date
    Apr 2007
    Location
    Sioux Falls South Dakota
    Posts
    358

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    Do you mean the patient had both the left and right ankle done? Your question sounds like one ankle, both the left and right side of that one ankle?

    20600 is for a small joint; 20605 is for an intermediate joint - so the correct code is 20605 for the ankle.

    If only one ankle, it would only be one code, 20605. If both the right and left ankles, you would bill 20605-50 to Medicare (at least our MAC wants it on one line with a 50 modifier). An alternate to one line with the 50 modifier is 20605-LT on one line, and 20605-RT on the other.

    Hope this helps,
    Last edited by cmcgarry; 11-08-2010 at 04:56 PM. Reason: added line about 20600 vs 20605
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  3. #3

    Default

    If the injection is in the medial and lateral side you can only bill for one injection. If it is both ankles then you really don't even need the 51 modifier. RT/LT is all you need.
    Last edited by banderson77; 11-10-2010 at 08:25 AM.

  4. #4

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    so if the pt had procedure 20605 preformed to the medial and lateral side of both ankles. We could only bill one injection with RT/LT?

  5. #5
    Join Date
    Apr 2007
    Location
    Sioux Falls South Dakota
    Posts
    358

    Default

    Quote Originally Posted by gmsttcoding View Post
    so if the pt had procedure 20605 preformed to the medial and lateral side of both ankles. We could only bill one injection with RT/LT?
    Please see my previous post - if done on both ankles, you could then bill one line with the 50 modifier or two lines, one with RT and one with LT, depending on what your carrier/MAC prefers.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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