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Hip Steroid injection

  1. Default Hip Steroid injection
    Exam Training Packages
    In an ASC setting am I correct in coding the following procedure with 20610?



    TECHNIQUE: The patient was brought to the procedure room and placed supine on the OR table. The right hip position was verified with the C-arm. The hip was prepped and draped in a routine fashion. A skin wheal was raised for anesthesia and a 22G needle inserted into the hip joint. The position was verified with an arthrogram. Depo-Medrol 1 cc and 1 cc Lidocaine was then introduced into the hip. The needle was withdrawn. A sterile dressing was applied. She was transferred to the cart and sent back to the recovery room to be dismissed.

    Thanks for any assistance.

    Debbie Youngberg

  2. Default To my Knowledge
    I have been working in an ASC for over 4 years and i am currently taking courses in coding. To my knowledge, coding this hip injection when performed in an ASC shold be a 27095, not a 20610. Medicare, however, does not cover this procedure when performed in an ASC, if this is a Medicare patient.

  3. #3
    I think the note looks like the shoulder "arthrogram" and steroid description previous post. Although the arthogram was noted to be performed that does not mean it was for the purpose of billing for athrogram and could be considered a steroid injection under 20610. There is not intent at documenting the interpretation for diagnostic purposes.

  4. Default Steroid Injection
    Thanks Dwaldman. I agree with you. That's the way I was looking at it and feel 20610 is the correct code. Just wanted to confirm with another person.

    Have a great day!

  5. #5
    Just saw this on June CPT Assistant, which is related to your question.

    Coding Clarification:Hip Arthrography

    A frequently asked question (page 11) in the February 2012 CPT Assistant newsletter inadvertently provided misleading instruction related to the reporting of a hip arthrography study. The question referred to a hip arthrogram under fluoroscopy while the answer referred to a hip injection under fluoroscopy, and therefore, the following revised Q&A with additional clarification is provided.

    Question: How is a small injection of contrast into the hip under fluoroscopic guidance reported when performed to confirm needle tip placement prior to the injection of steroids or an anesthetic?

    Answer: When a small amount of contrast is injected into the hip under fluoroscopic guidance to ensure proper needle location before administering an anesthetic or steroid injection, it is appropriate to submit code 77002, Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), to report the fluoroscopic imaging performed. Fluoroscopic guidance is the radiologic technique by which the images are produced. As stated in the descriptor nomenclature, code 77002 is used to describe fluoroscopic guidance for all types of needle placement, such as for biopsy, aspiration, injection, or placement of a localization device. The injection of a steroid or an anesthetic agent into the hip would also be reported using the joint injection code 20610, Arthrocentesis, aspiration and/or injection; major joint or bursa. To further clarify, Hip injection of an anesthetic or steroid under fluoroscopic guidance should not be confused with hip arthrography. When a conventional (radiographic) hip arthrogram is performed, it is reported with an arthrography injection code (code 27093, Injection procedure for hip arthrography; without anesthesia, or code 27095, Injection procedure for hip arthrography; with anesthesia), and the arthrography imaging code 73525, Radiologic examination, hip, arthrography, radiological supervision and interpretation. In this instance, code 77002 is not reported in addition to code 73525 because current imaging practice dictates that fluoroscopy [77002] is considered a component of organ/anatomic-specific radiological supervision and interpretation procedures (ie, 73525).

    The key is not the actual volume of contrast injected, but the intention. If the contrast is injected only to confirm needle position within the joint, the quantity does not matter. If instead the contrast is injected with the intention to outline the joint surface to perform a radiographic arthrogram, then it is an arthrogram even if only a few cc's of contrast material are injected. Again, it is not the volume of contrast but the intention that defines the service.

  6. #6
    Columbia, MO
    Quote Originally Posted by bbwixler View Post
    I have been working in an ASC for over 4 years and i am currently taking courses in coding. To my knowledge, coding this hip injection when performed in an ASC shold be a 27095, not a 20610. Medicare, however, does not cover this procedure when performed in an ASC, if this is a Medicare patient.
    these are 2 very different procedures for different purposes. Please do not use them interchangably depending on Place of service. A steroid injection into the knee is 20610 regardless of whether it is performed in the ASC or physician office or outpatient or inpatient.
    Your procedure note is the real clue as to what was performed.

    Debra A. Mitchell, MSPH, CPC-H

  7. Default Hip Steroid Injection
    To take this one step further, if this procedure is done under general anesthesia, what code should be used to bill the procedure?



  8. #8
    Also, Medicare does allow an SI Joint injection to be done in an ASC, you just have to bill it using G0260 rather than 27096, for what it's worth...
    Walker Bachman, CPC, CPPM

  9. #9
    If the hip joint injection is done under general anesthesia, it would be 01991 for supine positioning for anesthesia personel billing and 20610 is not differed by level of sedation adminstered such as how some "with general anesthesia" codes might have separate companion code for without anesthesia.

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