# Hip Arthrogram w Steroid Injection



## dyoungberg (Oct 4, 2012)

I recently billed this to Tricare as 20610 & 77003.  The have denied it as not covered at an ASC.  Has anyone had experience with this and if so how did you handle?

PREOP DIAGNOSIS:   LEFT HIP PROGRESSIVE DEGENERATIVE ARTHRITIS HIGHLY SYMPTOMATIC AND INTERFERING WITH ACTIVITIES OF DAILY LIVING 

POSTOP DIAGNOSIS:  SAME

PROCEDURE:   LEFT HIP ARTHROGRAM UNDER FLUOROSCOPY WITH INTRAARTICULAR STEROID INJECTION 

ANESTHESIA:  GENERAL ET 

INTRODUCTION:  Routine preop evaluation revealed no medical contraindications to the procedure. The patient and family were consulted at length regarding the relative risks, benefits, and alternatives to the above elected procedure. They understood these risks to include but not be limited to infection, sepsis, osteomyelitis, DVT, PE, stroke, MI, death, nerve or blood vessel damage, RSD, persistent pain, persistent stiffness, requirement for future operative intervention, among others. Understanding the above risks and that no guarantees were made nor implied, the patient freely consented to proceed. 

OPERATIVE PROCEDURE: Patient was taken to the operating room on 9/19/12 where she was transferred to the OR table and placed in the supine position without event. She was induced under general anesthesia and intubated via the ET route.  Prior to initiation of the operative procedure, the American Academy of Orthopedic Surgeons' timeout protocol was instituted. This assured the patient's name, the correct extremity, the correct side, the patient's allergies, their preoperative medications and antibiotics. Following completion of the appropriate timeout and verification of all the above, we proceeded with the operative procedure.  The left inguinal area was prepped and draped in usual sterile fashion. An 18G spinal needle was introduced 2 cm's inferior and 1 cm lateral to the ASIS, advanced into the anterior superior hip capsule under fluoroscopic guidance. Then, 2 cc radiocontrast was injected intra articularly to confirm the intraarticular placement of the needle. Thereafter, a 10 cc solution of 3 cc Celestone and 7 cc Marcaine was injected intra articularly with little resistance. The needle was withdrawn. There was no bleeding. A band-aid was utilized to cover the puncture site. The patient was thereafter extubated in the OR and returned to recovery in good condition. There were no noted complications. Sponge, needle, instrument counts were correct at the end of the operative procedure. EBL was nil.


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## dwaldman (Oct 8, 2012)

The one thing I noticed is I would use 77002 instead of 77003. I would appeal stating that 20610 is covered by other payers in an ASC setting. And should be consider for reimbursement.


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