# 20610 vs 27093



## codedog

I work  at an ASC , doc  office books it as 27093 ,while I insist its 20610. IF i AM wrong then ,then I will man  up and admit I am wrong , but if not what simple words can I explain  to doc office that they are coding it wrong 
 here is operative report 

POSTOPERATIVE DIAGNOSIS:  Hip degenerative joint disease.
OPERATIONS:  1.  Left intraarticular hip joint injection and aspiration.  2.  Fluoroscopic needle guidance.
ANESTHESIA:  2% lidocaine 5 cc and sodium bicarbonate 8.4% 5 cc; monitored anesthesia care.
BLOOD LOSS:  None.
FLUIDS GIVEN:  200 cc lactated Ringer's solution.
URINE OUTPUT:  None.
INJECTATE MIXTURE:  Preservative-free bupivacaine 0.5% 4 mL and Depo-Medrol 40 mg 1 mL.
PROCEDURE IN DETAIL:
Informed consent was obtained.  Operative site was marked in the holding area.  The patient was then taken to the procedure room and placed in a supine position on the table.  Skin was prepped with ChloraPrep solution and draped in a sterile fashion.  A time-out was performed.
Using fluoroscopy, the left hip was examined.  Skin wheal was raised.  Subcutaneous tissue was anesthetized with 2% lidocaine mixture.  Using an anterolateral approach, 22 gauge 5-inch spinal needle was directed with intermittent fluoroscopic guidance into the joint capsule.  Aspiration was significant for 6 cc of straw-colored fluid.  The aspirate was placed in a sterile container and sent to Pathology for routine cytology.
3 cc of Isovue M200 contrast was then injected during the live fluoroscopy.  Arthrogram confirmed correct needle placement.  There was no vascular uptake noted.  After negative aspiration, the injectate mixture was instilled through the needle.  The needle was then removed from the skin.


Band-Aid was placed over the skin entry site.  The patient was transferred to the recovery area, monitored for 30 minutes, then discharged after a normal neurologic exam. Postprocedure and discharge instructions were given to the patient.  There were no apparent complications.  The patient tolerated the procedure well.
PAIN BEFORE THE PROCEDURE:  9/10.
PAIN AFTER THE PROCEDURE:  0/10.
DISPOSITION:  Discharged to home in stable condition.  The patient is to return to the clinic in two weeks.




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## dwaldman

This Q and A below can be found on the AMA CPT Network, It mentions monitored anesthesia care as meeting "with anesthesia" descriptor.


KB #: 5038 
Date: 03/05/2010 

Anesthesia Guidelines 

Anesthesia 

Question 

Do the phrases with anesthesia or requiring anesthesia in CPT code descriptors preclude the reporting of anesthesia codes? 

Answer 

It should be noted that there are certain CPT code descriptors in the CPT codebook that include the phrases "with anesthesia" or "requiring anesthesia." These phrases indicate that the work involved in performing that procedure requires anesthesia, whether it is general anesthesia, regional anesthesia, or monitored anesthesia care. The appropriate anesthesia code is reported separately. Moderate (conscious) sedation is not an anesthesia service. 

But if you are searching the CPT Assistant archives you will  find

April 2005 CPT Assistant "The code descriptors, which include the phrase “requiring anesthesia” or “under anesthesia,” indicate that the work involved in that specific procedure requires the use of general anesthesia; therefore, it would not be appropriate to report code 23700 if general anesthesia is not provided.Jan 1999 CPT Assistant "From a CPT coding perspective, codes having the descriptor “requiring anesthesia” mean requiring general anesthesia." 


________________________

Is the physician also billing "73525 for the interpretation of the arthrogram."

I was reading thru the note to find the arthrogram description . The code says for hip arthrography, but the note sounds like it describes the steps in performing 27093/27095 but lacks a clear arthrogram report. 

Below the part about "no other pathology identified" is what I think the note is potentially missing in documentation.


Below is from AAOS 2005 link
http://www2.aaos.org/aaos/archives/bulletin/oct05/coding.asp


Injection of the hip under fluoroscopic guidance

Before injecting steroids into the hip area, physicians often inject dye and perform an arthrogram to outline the joint and confirm that the needle location is in the joint capsule and no other pathology is identified. In this case it would be appropriate to report code 27093—Injection procedure for hip arthrography; without anesthesia—along with code 73525 for the interpretation of the arthrogram. 

If a surgeon is just injecting the hip to confirm needle location and the intent is not an arthrogram, 76003 would be appropriate.


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## codedog

so 76003 with 27093 ?


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## dpeoples

trent123 said:


> I work  at an ASC , doc  office books it as 27093 ,while I insist its 20610. IF i AM wrong then ,then I will man  up and admit I am wrong , but if not what simple words can I explain  to doc office that they are coding it wrong
> here is operative report
> 
> POSTOPERATIVE DIAGNOSIS:  Hip degenerative joint disease.
> OPERATIONS:  1.  Left intraarticular hip joint injection and aspiration.  2.  Fluoroscopic needle guidance.
> ANESTHESIA:  2% lidocaine 5 cc and sodium bicarbonate 8.4% 5 cc; monitored anesthesia care.
> BLOOD LOSS:  None.
> FLUIDS GIVEN:  200 cc lactated Ringer's solution.
> URINE OUTPUT:  None.
> INJECTATE MIXTURE:  Preservative-free bupivacaine 0.5% 4 mL and Depo-Medrol 40 mg 1 mL.
> PROCEDURE IN DETAIL:
> Informed consent was obtained.  Operative site was marked in the holding area.  The patient was then taken to the procedure room and placed in a supine position on the table.  Skin was prepped with ChloraPrep solution and draped in a sterile fashion.  A time-out was performed.
> Using fluoroscopy, the left hip was examined.  Skin wheal was raised.  Subcutaneous tissue was anesthetized with 2% lidocaine mixture.  Using an anterolateral approach, 22 gauge 5-inch spinal needle was directed with intermittent_ fluoroscopic guidance _into the joint capsule.  Aspiration was significant for 6 cc of straw-colored fluid.  The aspirate was placed in a sterile container and sent to Pathology for routine cytology.
> 3 cc of Isovue M200 contrast was then injected during the live fluoroscopy.  _Arthrogram __confirmed correct needle placement_.  There was no vascular uptake noted.  After negative aspiration, the injectate mixture was instilled through the needle.  The needle was then removed from the skin.
> Band-Aid was placed over the skin entry site.  The patient was transferred to the recovery area, monitored for 30 minutes, then discharged after a normal neurologic exam. Postprocedure and discharge instructions were given to the patient.  There were no apparent complications.  The patient tolerated the procedure well.
> PAIN BEFORE THE PROCEDURE:  9/10.
> PAIN AFTER THE PROCEDURE:  0/10.
> DISPOSITION:  Discharged to home in stable condition.  The patient is to return to the clinic in two weeks.
> 
> 
> 
> 
> _____________________________________



Trent, I agree with you. I would code this 20610/77002
All radiolographs are understood to be diagnostic unless otherwise specified; localization is not diagnostic so no "arthrogram" was performed. 76003 is not a valid code, 77003 is for spinal/paraspnial guidance.

HTH


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## brockorama01

Ditto.

Another way to explain it that 27093 is the injection code just for an arthogram (diagnostic).  Code 20610 is therapuetic....but it is confusing.


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