# Multiple units of 20551



## iowagirl77 (Dec 9, 2016)

Hi, my physician is billing 20551 for injection at the left and right lateral epicondyle as well as the left medial epicondyle. I see that LT, RT and 50 are not options. Would you put one unit per line with the appropriate dx and a 59 mod on the 2nd and 3rd lines, or would you put it all on one line with a quantity of 3 and all 3 dx linked to it? Thanks!


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## dwaldman (Dec 13, 2016)

I would look at the below Supercoder article, I think their advice on making sure the documentation supports the procedure describes it being performed at the tendon origin/insertion in order to even bill 20551. They also point out tennis elbow injection can be seen to be reported as 20550.

There is a difference in payment with Medicare total  RVU of 1.71 of 20551 at a higher rate than 20550 at RVU of 1.67.

Additionally, AMA CPT Assistant 2003, describes that both CPT codes (20550, 20551) have the plural form of injections(s) in their code descriptors which would require the documentation to support: " multiple tendon sheaths, tendon origins, tendon insertion, or ligaments are reported one time for each injection"

The CMS MUE edit describes coverage for up to 5 units of 20550 or 20551. Possibly if the documentation supports multiple separate injections of tendon origins/insertions or sheaths on one side with an additional injection on the contralateral side, then potentially a total of the 3 units could be reported and ultimately the 2 and third unit would be paid at 50 percent, or the carrier might require modifier 50 with 2055X then an line 2055X with the 51 modifier. But if the documentation supports the 3 separate injections, I believe it would be reported with 3 units; at least this is the way I have been instructed for multiple joint injections that have been bilateral in addition to additional joint from carrier instructions from WPS Medicare J5. 
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20551  
Injection(s); single tendon origin/insertion  

20550  
Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia")  

______________________
Supercoder website Q & A
https://www.supercoder.com/coding-n...551-for-elbow-epicondylitis-injection-article

Question: What is the best code for an injection to treat elbow epicondylitis?
Missouri Subscriber

Answer: When your physician does this procedure, she generally is injecting the insertion, which is 20551 (Injection; single tendon origin/insertion). However, CPT's section on elbow introduction or removal includes the notation, "for injection of tennis elbow, use CPT 20550" (Injection, single tendon sheath, or ligament, aponeurosis [e.g., plantar "fascia"]). Code 20551 might be the best choice in many cases, but check your physician's documentation to be sure you shouldn't be reporting 20550 or another code instead.
___________________________________
AMA CPT Assistant September 2003 page 13

Coding Update:Tendon Sheath Injections

This article was referenced on page 9 of the October 2014 issue in the article Trigger Point Injections Using "Dry Needling" Technique. 

In this article, we will focus on codes for injection(s) of a tendon sheath ligament (20550) and injection(s) of tendon origin/insertion (20551). Although the parent code (20550), indicates, "Injection(s)," codes 20550 and 20551 should be reported one time for multiple or single injections to a single tendon sheath, ligament, tendon origin, or tendon insertion performed. Thus, multiple injections to the same tendon sheaths, tendon origins, tendon insertion, or ligaments would be reported one time only, while injections to multiple tendon sheaths, tendon origins, tendon insertion, or ligaments are reported one time for each injection.


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## daedolos (Apr 18, 2017)

*Query*

How would you code for two injections on the right shoulder and one injection on the right knee?

20610-RT
20610-XS-RT

then what would the third code be?

Peace
?_?
Any advice is much appreciated.


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## dwaldman (Apr 22, 2017)

daedolos,

For at least WPS Medicare they would have you add the injections quantity on one line for multiple unilateral injections of different joints. 

I would look at what are the two injections at the shoulder, Sometimes you will se the AC joint in the shoulder 20605 with the glenohumeral joint 20610. The other anatomical location I have seen is the subacromial space which I have used 20610. I would just confirm what the two areas were to make sure it represents multiple units.


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## marvelh (May 4, 2017)

FYI: from the Medicare NCCI Manual:
CPT codes 20600-20611 are a family of codes describing arthrocentesis for aspiration and/or injection of different sized joints or bursae with or without ultrasound guidance. The unit of service (UOS) for each of these codes is a joint and its surrounding bursae, if any. A physician should not report more than one (1) UOS for arthrocentesis of any one joint regardless of whether or not the physician also aspirates or injects one or more of its surrounding bursae. For example, if a physician performs arthrocentesis of the shoulder and two bursae of the same shoulder without ultrasound guidance, only 1 UOS of CPT code 20610 may be reported.​


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## daedolos (May 12, 2017)

1 injection to subacromial area of right shoulder
1 injection to glenohumeral area of right shoulder
1 injection to medial area of right knee

Peace
@_*
So I should report the two shoulder codes as 20610-RT with J1040x2 and the knee code as 20610-XS-RT with J1040.  Thank you for the clarification.


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## dwaldman (May 18, 2017)

daedolos,
My previous post did not take in account the CMS NCCI Policy manual regarding the joint and the bursa area being injected that should only one unit in the same shoulder. So I believe that you also saw the additional post with the NCCI guidance and you have 20610 (1 unit)  for the shoulder that did have the two injections in the same shoulder and then the knee injection with the XS modifier. I believe it is correct.


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