# Major joint injection x 2



## dyoungberg (Jan 28, 2013)

If doctor states he did right shoulder injection x 2 of Naropin & Decadron under fluoroscopy, is it correct to bill 20610 x 2 or just once?

Thanks

Debbie
Billing Representative
NW FL Surgery Center


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## emagel@aqreva.com (Jan 28, 2013)

I would only code this once. The definition states that if a aspiration and injection is done at the same session to only code this once. I would assume that it would also suggest that if two drugs were injected we would still only bill this once.


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## dwaldman (Jan 31, 2013)

I require they indicate what was injected within the shoulder joint: they have to specifically state:  Glenohumeral (20610), Subacromial space (20610) or Acromioclavicular joint (20605). I would look at what was documented as injected and what the reasoning was to perform two separate injections. There are times where I have billed for an injection of the GH and AC joints 20610 20605. But the documentation has to  very clear.


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## dyoungberg (Jan 31, 2013)

dwaldman said:


> I require they indicate what was injected within the shoulder joint: they have to specifically state:  Glenohumeral (20610), Subacromial space (20610) or Acromioclavicular joint (20605). I would look at what was documented as injected and what the reasoning was to perform two separate injections. There are times where I have billed for an injection of the GH and AC joints 20610 20605. But the documentation has to  very clear.



Thanks all!   dwaldman I understand what you're saying.  Dr injected Naropin & Decadron into the bicipial groove and the AC Joint.  Would this warrant 20610 x 2 with a modifer 59 on the 2nd injection?

Thanks again!
Debbie


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## dwaldman (Feb 2, 2013)

Biceps (bicipital) tendonitis is an inflammation of the long head of the biceps tendon as it passes through the bicipital groove of the anterior humerus  

The medial bicipital groove is seen on the surface anatomy of the upper arm. It is formed by the hollow between the biceps and triceps muscles.

It should be distinguished from the bicipital groove or intertubercular sulcus, which is not a surface anatomy structure. It is the groove where the long head of biceps tendon runs between the greater and lesser tubercles below the humeral head before inserting into the superior glenoid rim.

The lateral bicipital groove is seen on the lateral aspect of the upper arm, and is formed by the same anatomical structures as the medial groove.

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Although 20610 & 20605 do not have bundling issues. I would confirm what was injected at the bicipital grove location, I copy an pasted some information from wikipedi and another site I found on a internet search. If this was a tendon injection at this location (20550) it would bundle with 20605

Code 20550 is a column 2 code for 20605 , but a modifier is allowed in order to differentiate between the services provided.
*Use modifier with code 20550
CCI edit Rule:
Misuse of column two code with column one code

AC joint injection has to be reported with 20605 due to it being include in the descriptor,

Arthrocentesis, aspiration and/or injection; intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa)

If this ends up being a tendon injection (20550) at the biciptal grove, I believe the edit would be for the contralateral shoulder to apply the contralateral shoulder so you would reporting only the AC joint injection.


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