# Spine,hip & knee injections



## dyoungberg (Feb 15, 2013)

I coded this procedure to Medicare as 64493 rt, 64493 lt, 20610-59 (Bursa) & 20610-59 (Knee). Medicare has denied the 20610 x 2 as being included in the 64493.  Here is the Op Note:

PREOPERATIVE DIAGNOSIS:        DEGENERATIVE LUMBAR FACET DISEASE, L5-S1, BURSITIS, RIGHT HIP, ARTHRITIS, RIGHT KNEE 

POSTOPERATIVE DIAGNOSIS:      DEGENERATIVE LUMBAR FACET DISEASE, L5-S1, BURSITIS, RIGHT HIP, ARTHRITIS, RIGHT KNEE 

PROCEDURE:           1.         C-ARM LOCALIZATION LUMBAR FACETS L5-S1 BILATERALLY
2.         INJECTION OF THE LUMBAR FACETS L5-S1 BILATERALLY
3.         C-*ARM LOCALIZATION OF THE GREATER TROCHANTER
4.         INJECTION OF THE GREATER TROCHANTER BURSA 
5.         INJECTION, RIGHT KNEE 

TECHNIQUE:   The patient was placed prone on the operating room table and the lumbar spine was prepped and draped in a routine fashion.  The C-arm was used to localized the facet joints at L5-S1 and they were both then injected with a mixture of 8 cc of 1% Xylocaine and 2 cc of Kenalog.  The C-arm was used to localize the greater trochanteric bursa and trochanter after a sterile prep, Lidocaine was used to anesthetize the skin and then an injection of 4 cc of 0.5% Marcaine and 1 cc of Kenalog was injected into the trochanteric bursa.  Sterile dressing were applied.  She was then rolled over and placed supine.  The knee was prepped and draped in a routine fashion and then 2 cc of Xylocaine and 1 cc of Kenalog was injected into the knee.  Sterile dressing was applied.  She was then transferred to the cart and sent to the recovery room.  

Can anyone tell me if I was correct in the way I coded this and if so how should I proceed in appealing to Medicare?

Thanks and Happy Friday!

Debbie
Billing Representative
NW FL Surgery Center


----------



## mitchellde (Feb 15, 2013)

what was the dx codes you used and how were they linked?


----------



## dyoungberg (Feb 22, 2013)

Hi Debra,  I coded 64493 with dx code 721.3, 20610 w 726.5 for the hip and 20610 w 716.96 w knee.


----------

