# Injection help - code is correct



## taurus7694 (Mar 23, 2009)

Can anyone clarify which injection code is correct when the pes arsenine of the knee is injected.  Our Dr. is coding it as 20551, but we had information leading us to believe it was 20610.  Any help is appreciated.


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## Anna Weaver (Mar 24, 2009)

*injection*

I'm not really familiar with this myself but this is what I found:

http://emedicine.medscape.com/article/308694-overview
Pathophysiology
Pes anserinus is the anatomic term used to identify the insertion of the conjoined tendons into the anteromedial proximal tibia. From anterior to posterior, the pes anserinus is made up of the tendons of the sartorius, gracilis, and semitendinosus muscles. The tendon's name, which literally means "goose's foot," was inspired by the pes anserinus's webbed, footlike structure. The conjoined tendon lies superficial to the tibial insertion of the medial collateral ligament (MCL) of the knee.


Other Treatment
Intrabursal injection with local anesthetics and/or corticosteroids is a second line of treatment. A study found no difference in short-term pain relief afforded by 3-5 mL of 1% lidocaine with or without methylprednisolone. Injection can be directed to the point of maximal tenderness. Take care to avoid injection within the tendons themselves. Occasionally, an area 0.5-1 cm higher than the tendons is injected in order to include the MCL bursa, which also may be a pain generator. Relief is usually immediate but may not be complete.

Repeated lidocaine injections or the use of corticosteroids may result in longer-lasting relief (from 1 to several months). Generally, use a 22-gauge or 23-gauge needle to inject 1-3 mL of 1% lidocaine and corticosteroid (20-40 mg of triamcinolone, 20-40 mg of methylprednisolone, or 6 mg of betamethasone). If infection—which is rarer here than in the bursae of the anterior knee—is suggested, use a larger, 19- or 20-gauge needle and a 20-30 mL syringe for aspiration. Patients who do not respond to initial injection rarely respond to repeated bursal injections. Injection of the knee joint itself may be beneficial in recalcitrant cases.

20551-injection; single tendon origin/insertion
20610-arthrocentesis, aspiration and/or injection; major joint or bursa.

It looks like this could go either way. I think I would use the 20551 for the injection unless it states as in the last sentence that the knee joint itself is injected. But, I would confirm this with dictation and/or ask the Dr. 

Anyone else?


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## taurus7694 (Mar 24, 2009)

*Thank you*

I appreciate the information ...thanks...it helped!


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## kmhall (Mar 27, 2009)

*Bursa aspirations/injections-multiple?*

I have a quick question regarding bursa aspirations/injections.  Our doc did an aspiration on the prepatellar bursa AND separate aspiration on the infrapatellar bursa (20610).  Then he injected BOTH bursa post aspiration with 40 cc of kenalog.  Does this count as 2 injections, 4 injections??  Help!!


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## taurus7694 (Apr 1, 2009)

When the doc does an aspiration and then an injection into one area, it is just coded with one 20610 (or other appropriate inj code).  In your scenario, it would just be 2 (inj) codes...not 4....hope that helps!


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## kmhall (Apr 1, 2009)

Yes.  Thank you.


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