# Hip injection with dye contrast. Please Help!



## ortho1991 (Aug 30, 2013)

Hi,

We have been going back and forth with this procedure.

This procedure is done in our office in our x-ray suite we own the equipment, here is the note that the phyician dictates.


Left intra-articular hip injection wth dye contrast.

Patient brought into the radiology suite.

Patient was placed in the supine positon on the flouroscopy table.  The area over the LT hip laterality of the injection was uncovered and draped.  Using flouro, a pont over the femoral neck was identified as the target and marked.  The skin over the injection site was cleaned------ After numbing the skin with topical ethyl chloride ------lidocaine was then used to infiltrate and anesthetize the skin and subcutaneou tissue along the path of the injection.

A 22 gauge needle was then advanced through the anesthetized skin and subcutaneous tissue using intermittent fluoro guidance until reaching the bone at the trget region.  After negative aspiration of air, CSF, heme, or fluid, 1cc of Omnipaque 180 dye was injected highlighting the joint space.  An imape copy was then printed for documentation  and placed in the patien's chart. Again after  negative aspiration for air------- a solution of----
lidocaine and 2 cc of 40 mg Depo-Medrol was then injected into the trget.  The 22-gauge needle was the removed while being flushed with lidocaine.

Should this be coded with 20610,77002,  or is this the correct way to code 27093,73525,   J1040,Q9965.

How do we know when it's just 20610, 77002


Please, please any advice on this will be appreicated.

Thank you,


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## johnmeyer (Sep 1, 2013)

I think it would be better for the provider to note "left hip intra-articular injection with arthogram" rather than "Left intra-articular hip injection wth dye contrast".

We use 73525 when giving a hip injection in leu of 77002, but our PM doc always notes that he's doing a hip arthogram for needle guidance.

I'd code as (assuming a hip arthogram was done):

20610-LT
73525
J1040

If all your provider is doing is a hip joint injection (aka an intra-articular hip injection), then 20610 would be proper. You shouldn't allow yourself to get wrapped around the term "intra-articular" (if that's the issue) since all that means is within the joint. In orthopedics, most injections are really intra-articular anyway.


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## ortho1991 (Sep 5, 2013)

I'm not doubting what you said billed correctly this is just a 20610, just trying to get ths straight in my head, may not be possible but I'm trying.

As I read this note I though he did an arthrography 27093 with injection 20610.

What are the requirements to bill 27093, in what instance could you bill 27093?  Is an arthrography for diagnostic purposes only?  Any examples or guidance would be very much appreciated.

Thank you again for taking the the time to help.


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## dwaldman (Sep 5, 2013)

I would have a meeting with the physician and those involved to determine what the intention of the procedure is.

If the procedure requires a contrast but does not have diagnostic intention that would assist the doctor with future treatment of the patient. For example, after complete the procedure does this provide additional diagnostic information that can not be obtained with a MRI or CT or Xray or MR arthrogram.

If the physician relays the intention is more for pain relief and is not to further diagnosis the patient's hip condition then I would report 20610 77002


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## johnmeyer (Sep 7, 2013)

I did a little research and found this on WebMD (love that web site) to support using 73525:

An arthrogram is used to: 

Find problems in your joint capsule, ligaments, cartilage (including tears, degeneration, or disease), and the bones in the joint. In your shoulder, it may be used to help find rotator cuff tears or a frozen shoulder.
Find abnormal growths or fluid-filled cysts.
Confirm that a needle has been placed correctly in your joint before joint fluid analysis, a test in which a sample of joint fluid is removed with a thin needle.
*Check needle placement before a painkilling injection, such as a **corticosteroid** injection.*
http://arthritis.webmd.com/arthrogram-joint-x-ray


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