# need help with 2 procedures...urgent



## consultingbykristin (May 2, 2013)

Physician performed a chondrocostal injection and an injection of the thoracic nerve at the scapula.

The area over T5-T8 was prepped with Betadine and a 25-gauge needle placed in the chondrocostal joint at T5-6 and T6-7 under fluoroscopic guidance.  2cc of 0.5% marcaine with epinephrine plus 20mg of Kenalog were injected at each of these two sites.  Along, the long thoracic nerve at the same level just to the medial aspect of the scapula was injected through a #25-gauge needle with an additional 20mg of Kenalog plus 2cc of Marcaine 0.5% with epinephrine.

Would this be coded 64421 or 20605 x2 for the chondrocostal injection and 64520 for the thoracic nerve?


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## dwaldman (May 4, 2013)

The costochondral  joint would be reported with 20600 since it seems after reviewing pictures of the anatomy it appears closer to the size a small joint compared to the size describe by intermediate size joint injection (ie, wrist, elbow, ankle). I agree that you could report (x 2) if two separate joint injections were provided.

For the long thoracic nerve block, when viewing the below link

www.anesthesia-analgesia.org/content/71/2/197.abstract

I did not see that it fell under the intercostal nerves, and there was only a single injection provided which would not support a multi-intercostal nerve block that would require multiple injections. Although they have a CPT for a single injection for an intercostal nerve block (64420) I would lean more towards 64450 for the long thoracic nerve block. 

NCCI has 64450 bundled as a column two code to column one code 20600. Would need to determine if the procedures qualify for separate anatomical sites to support 59 modifier. 
I don't regularly report the procedures described in your post so this is just a suggestion and other forum members might have a different interpretation on how this should be reported.


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## marvelh (May 6, 2013)

Per October 2007, CPT Knowledgebase response:
From a CPT coding perspective, it would be appropriate to report CPT code 20605, Athrocentesis, aspiration, and/or injection; intermediate joint, bursa or ganglion cyst (i.e. temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa), for costochondral joint injections.​


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## dwaldman (May 10, 2013)

Kristin, 

I hope you see the other response you received which shows the documentation that supports 20605 for the procedure in question.  My personal interpretation of using 20600 was in error.


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## consultingbykristin (May 16, 2013)

Thank you for the information/responses!


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