# 20550 or 20605



## Blackhorse (Oct 19, 2017)

Dr used 20550 for the injection but I think it should be 20605.  What do you guys think?



Physical Exam
The pt. walks with an antalgic gait.  Pain is aggravated by walking on her toes.  There is no increased warmth.  There is some mild swelling in the retro calcaneal area of the right tendo Achilles insertion.  There is no swelling of the tendon.  There is no bony tenderness.  Neurocirculatory status is intact.

Diagnostic Studies
AP, lateral and oblique x-rays of the right foot show some calcium deposit just deep to the tendo Achilles insertion where there is a spur at the insertion.  Bone quality is good.  Joint spaces are otherwise well maintained.

Impression 
Retro calcaneal bursitis with severe pain, right ankle.

Plan/recommendation
A recommendation was made for the patient to consider cortisone injection followed by wearing a Cam Walker to limit stress on the tendo Achilles insertion.  The patient consented.
Right Ankle/Heel Injection:
The patient's right ankle was sterilely draped and the prepped with ChloraPrep.  Skin was topically anesthetized with ehyl chloride and then locally anesthetized with 0.25% Marcaine and 1% lidocaine.  2cc of 1% lidocaine and 2cc 0.25% Marcaine along with 1cc of betamethasone or 6mg was injected into the inflamed area.  The patient tolerated the injection well.  ChloraPrep was removed with alcohol and a bandage applied.
The patient was fitted with a Cam Walker.  She will be seen back in 2 weeks for reevaluation.




Thank you.


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## Katie_Ellis (Oct 25, 2017)

If provider doesn't document that the tendon was injected, I would use the 20605. Also, the diagnosis is bursitis so that is going to justify the 20605 also.


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## daedolos (Oct 25, 2017)

20605-RT

Peace
@_*
Agreed


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