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20605 with E/M????

  1. Default 20605 with E/M????
    Medical Coding Books
    Hello,
    I have a question. I code for a podiatrist, in the past we have coded an E/M code of 99213 with the 20605 code, which is an injection for plantar fascitis. Lately, the insurance companies will not cover the E/M code, which an evaluation is needed to determine if another injection is needed or not, so the physician has the patient come back on a separate visit for the injection. Is there an E/M code that someone else uses with injections such as this that will pay with the injection, or do your podiatrists do the same thing?
    Thank you!
    Kara Silvers

  2. #2
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    Quote Originally Posted by karasilvers View Post
    Hello,
    I have a question. I code for a podiatrist, in the past we have coded an E/M code of 99213 with the 20605 code, which is an injection for plantar fascitis. Lately, the insurance companies will not cover the E/M code, which an evaluation is needed to determine if another injection is needed or not, so the physician has the patient come back on a separate visit for the injection. Is there an E/M code that someone else uses with injections such as this that will pay with the injection, or do your podiatrists do the same thing?
    Thank you!
    Kara Silvers
    Injection codes include an E/M unless it is SIGNIFICANT and SEPARATE from the surgical code (20605). A portion of the rvu for injections is for e/m related to injection. I usually think about the modifier I have to use.....25.......which clearly states the visit has to be significant and separate from the procedure.

    There is very good article on this aaos october 2009 issue. If you cant get it you can send me private email with your fax #.

    By the way, I dont typically bill 20605 for plantar fasciitis, is he injecting the joint? or fascia?

  3. #3
    Location
    Green Bay, WI
    Posts
    71
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    If the patient required an evaluation to determine if another injection should be given for their dx of plantar fasciits, in my opinion, the E/M would be significant & separately identifiable & I would report the E/m code with modifier -25. This should be allowed by insurance companies.

    And I agree with Plaidman, I wouldn't bill CPT 20605 for an injection for plantar fasciitis. I would bill CPT 20550 (Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia").

    Have a great day!

  4. #4
    Default
    I work in Ortho practice and we have a lot of patients with plantar fasciitis. I would bill E/M+25; 20550.
    CPT 20605 if for joint or bursa. I would not bill E/M only if inj was planned in advance.

  5. Default
    We have always billed 20605 for plantar fascitis, especially if this is due to a heel spur.

  6. #6
    Default
    Quote Originally Posted by karasilvers View Post
    We have always billed 20605 for plantar fascitis, especially if this is due to a heel spur.
    This CPT is for joint or bursa it is not right to report it for plantar fascia inj.

    20605-After administering a local anesthetic, the physician inserts a needle through the skin and into a joint or bursa. A fluid sample may be removed from the joint or a fluid may be injected for lavage or drug therapy. The needle is withdrawn and pressure is applied to stop any bleeding. Report 20600 for arthrocentesis of a small joint or bursa, such as of the fingers or toes; 20605 for an intermediate joint or bursa, such as the wrist, elbow, ankle, olecranon bursa, or temporomandibular or acromioclavicular area. Report 20610 for a major joint or bursa injection or aspiration, such as of the shoulder, hip, knee joint, or subacromial bursa.
    20550-The physician injects a therapeutic agent into a single tendon sheath, or ligament, aponeurosis such as the plantar fascia in 20550 and into a single tendon origin/insertion site in 20551. The physician identifies the injection site by palpation or radiographs (reported separately) and marks the injection site. The needle is inserted and the medicine is injected. After withdrawing the needle, the patient is monitored for reactions to the therapeutic agent.

  7. #7
    Location
    Green Bay, WI
    Posts
    71
    Default
    I agree 100% with the above. CPT 20605 is not correct for injection of the plantar fascia with or without a heel spur. The plantar fascia is a thick band of connective tissue that runs across the bottom of your foot. It is not a joint or bursa; therefore, CPT 20605 would not be appropriate. CPT 20550 specifically notes that this code is for injection of the plantar "fascia".

  8. #8
    Location
    Springfield, Mo
    Posts
    388
    Default
    As far as charging an E/M code with an injection.... we use an E/M code for the first visit at which an injection is done. For subsequent injection visits, we only bill an E/M IF there is either a new problem, or a new treatment for the existing problem. In that case, E/M is warranted. Otherwise, just the injection code.
    solocoder CPC

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