# 2ND REQUEST-Hip,Knee & facet injections



## dyoungberg (Mar 1, 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. 

I coded this as 64493 dx 721.3, 20610 (hip) dx 726.5, & 20610 ( knee) dx 716.96.

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-CPC
Billing Representative
NW FL Surgery Center


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## christina_phelps (Mar 1, 2013)

64493 can be billed with a -50 modifier.  According to the NCCI edits (Jan. 2013), when you look up 64493, 20610 is listed in the 2nd column with a 1 in the 6th column.  Therefore, it is only available to be unbundled in special circumstances and with the correct modifier.


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## dyoungberg (Mar 6, 2013)

*Hip,knee & facet injections*



christina_thompson said:


> 64493 can be billed with a -50 modifier.  According to the NCCI edits (Jan. 2013), when you look up 64493, 20610 is listed in the 2nd column with a 1 in the 6th column.  Therefore, it is only available to be unbundled in special circumstances and with the correct modifier.



Hi Christina,

Thanks for your response.  If I am understanding you correctly 20610 can be billed twice with a modifier 59 as they are injections into the knee and hip, in addition to the facet injections. (3 separate areas of the body) Is this correct?

Thanks again!

Debbie, CPC
NW FL Surgery Center


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## dwaldman (Mar 9, 2013)

I would believe you have the correct coding and would have to appeal and see if they are going to have an issue with paying joint or bursa injections in addition to facet injections in the same encounter. I noticed you had 716.96 for arthritis of the knee. In the future, you can have the physician potentially be more specific such is he referring to osteoarthritis and if so, is it primary or secondary. Below is from AHA Coding clinic.



AHA Coding Clinic 1995

Degenerative joint disease, bilateral 

Body:  
Question:

When a patient has degenerative joint disease of both knees, what is the correct code assignment? We assigned code 715.96, Osteoarthrosis, unspecified whether generalized or localized, knee. Should we utilize a code that identifies multiple sites, e.g., code 715.06, Osteoarthrosis, generalized, knee (involving multiple joints)?

Answer:

Assign code 715.36, Osteoarthrosis, localized, not specified whether primary or secondary, for bilateral degenerative joint disease, knee. In the Tabular List (Volume 1), under category 715, Osteoarthrosis and allied disorders, an instructional note can be found:

NOTE:Localized, in the subcategories below, includes bilateral involvement of the same site.

This note should be interpreted to mean that bilateral involvement is included in the fifth digit for that site. Furthermore, when the degenerative joint disease affects only one site but is not identified as primary or secondary it is coded to 715.3x, Osteoarthrosis, localized, not specified whether primary or secondary. If it involves more than one site but is not specified as generalized, assign code 715.8x, Osteoarthrosis involving, or with mention of more than one site but not specified as generalized.


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## dwaldman (Mar 9, 2013)

https://www.aapc.com/ICD-10/icd-10-codes.aspx

It appears they have just unspecified in the descriptor for the 716.9x or 715.9x not specified as localized or generalized in ICD-10

For 716.96, it only crosswalks to M12.9 Arthropathy, unspecified 

For 715.96----M17.9 Osteoarthritis of knee, unspecified


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