# Joint Injections



## srziegler

One of my doctors does joint injections of the large joints (20610). He administers J3301, J2001, J0670 (kenallogg, marcaine, and lidocaine) in a premixed solution. The Medicare appeals line told our office that we should be adding a 59 modifier to the J2001 (lidocaine) for it to be paid. However it is all part of the same injection. Does anyone know how this can be correct?

Thank you


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## thompsonsyl

Hi,

I thought your question was really interesting.  I didn't realize that a modifier -59 could be used on J codes.  I looked up cpt 20610 on the CCI Edits and it does list J2001 as a component code, however, the modifier indicator is (1) so a -59 is allowed to unbundle it.  

My thinking is that since the injection site has to be anesthetized with the lidocaine in order to perform the arthrocentesis, it is considered "included".  By adding the -59 modifier, you are telling Medicare that there is some reason why you are unbundling the lidocaine from the arthrocentesis being done.  Does your MD use lidocaine for other than blocking the injection site?

Hope this helps & thanks for helping me to learn something new from your question!


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## safnlp

if you look up in the hcpcs you can not bill for lidocaine any more  it is bundled in to the procedure


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## Catherine.

The marcaine and lidocaine and kenalog are for pain relief and are not to be reported seperately when administered with another drug. (such as cortisone, synvisc etc.)


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## Lisa Bledsoe

The kenalog is billable, but not the marcaine/lidocaine.  If you read the description for J2001 it is for INTRAVENOUS infusion.


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## Trendale

*The use of modifier 25 with E/M and injections*



Lisa Curtis said:


> The kenalog is billable, but not the marcaine/lidocaine.  If you read the description for J2001 it is for INTRAVENOUS infusion.



In regards to 20610 and J2001, is it appropriate to bill this with an E/M visit and should a modifier 25 be attached or would the injection be included in the E/M visit?


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## RebeccaWoodward*

This is a hot topic in our office.  IMHO, I see no problem billing an e/m code if the physician assess' the patients complaint and with his medical decision making, decides to perform a joint injection.  Now...if the physician offers the joint injection and the patient wants to "think about it" and comes in a week later for the injection, no, don't bill an e/m (again) with the joint injection.  I feel that that the physician already provided the medical decision making for the e/m in the previous visit...therefore, only bill the joint injection with the kenalog.  Medicare also told our office to apply the modifier 59 to the lidocaine injection, which was incorrect!  Hope this helps~


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## Lisa Bledsoe

You can only bill the E/M with mod -25 if there is a significant separatey identifiable E/M from the reason for the joint injection.  J2001 cannot be billed as it is for intravenous injection.


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## kandigrl79

I agree with Lisa, up until two weeks ago, I worked for a very large ortho practice and you cannot bill for the lidocaine, you should bill the joint injection (20610) with the kenalog (j3301) and that's it.  As far as the modifier 25 even if the doctor did the medical decision making for the e/m and the patient agreed to the injection, you cannot bill the e/m unless you evaluated the pt. for some other problem (hence modifier 25 which stipulates separately identifiable e/m service).  Say for example the pt. presents complaining of knee pain and wrist pain, the doc. may decide to inject the knee and just watch the wrist, well in that case you could bill the e/m with modifier 25, but if the pt. simply presented with knee pain and the doc. decided to do a knee injection, you could only bill the injection and the drugs.


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## nikkisgranny

The use of when to use or when not to use -25 has me confused. The more I try to understand it the worse it becomes. Working in an ortho office, we, of course, do injections all day long.

New patients: Bill an E/M with a -25?

Established patient: New problem of knee pain; doctor suggests getting an injection (20610) to help calm the symptoms-bill E/M with -25 or just bill the procedure? What if they are following up on a current knee issue and the doctor suggests trying an injection for theraputic reasons?


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## Rhonda Buckholtz CPC

A simple way to possibly remember for the knee injections is that if they came in and it was not determined prior to the visit that an injection was to be done you could bill the E/M (if provided and significant). If the patient is coming in for an established treatment plan of injections you would not bill an E/M unless the patient encountered additional problems etc.

does this help?


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## Trendale

*Injection with E/M- Orthopedics*

Thank you very much! This information has helped me to understand this more clearly.


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## RebeccaWoodward*

This was taken directly from Medicare's website:

If the diagnosis referenced for the E&M service and the procedure are the same it would be expected that the diagnosis is for a new sign or symptom and not related to signs or symptoms treated in the recent past. For example, an established patient has been treated for fibrositis eight months ago and now returns with a sore area in the upper back. The physician evaluates the patient and decides that the painful area represents a new trigger point, and should be injected with a steroid and the injection is given. The decision to treat the new sign or symptom can not be made until the evaluation is completed and thus the -25 modifier should be placed on the E&M service

http://www.cignagovernmentservices.com/partb/pubs/mb/2001/01_5/nc/b0105nc08a.html

Rebecca


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## jbagsic

are there anymore legit links with regards to this topic? i can't find it anywhere else. something more up to date? thanks.


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## Kimberley

*Two joints injected*

We performed a fluoroscopic guided injection of two joints in the foot, talonavicular joint and navicular cuneform joint with 40 mg of Kenalog.....is is to correct to bill

20605 x 2
77002
j3301 x 4


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## CVARGAS

*Administration for the Injections*

Do i have to bill 96372 for the Injections?


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## mitchellde

For a Joint injection???   Never, 96372 is for administration of IM or SQ, 20600-20610 is administration of joint injections


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## CVARGAS

*Administrations for the Drugs*

What about the administration for the J3301 , J2001? Can i bill 96372 as the administrations for those codes?  We are billing the 20610 but before performing the service we have to put those injections and i want to know if i bill the 96372. Also if there are 2 drugs injected how many units do i use for the administration? 

Example: 99205 ,96372 ( How many units? ), J7799 ,J2001, J3301 ,99070 and 20610. 

Thanks.


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## RebeccaWoodward*

Couple of issues I can quickly identify... J2001.  This is not billable.  The method of administration is through *IV* not through a shot.  Another possible issue...99205.  This requires a comprehensive history and exam and medical decision making of high complexity.  Were there other issues/problems addressed during this visit other than the need for a "joint injection"?


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## CVARGAS

*Correct process*

It looks like it is for the evaluation before doing the 20610.  Just to be clear one more time. I don´t have to bill 9372 because J injections are given through IV. Please clarify. 

Thanks


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## mitchellde

This specific  J code for Lidocaine is only billable if the lidocain is given IV, any other route of administration is deemed for patient comfort and is not n=billable with a J code nor administration code.  As far if this is a 99205, You need to evaluate the documentation to see of ti meets the criteia for a 99205  If so then you may bill the level with the 25 modifier with the 20610 for the administration and the j code for the kenalog.  You just cannot bill for the lidocain as there is no code for it.


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