# Aspiration & Injection - In an ASC setting



## dyoungberg (Jan 28, 2013)

In an ASC setting Dr performed the following procedure:

_POSTPROCEDURE DIAGNOSIS:SYNOVITIS AND DEGENERATIVE ARTHRITIS, RIGHT HIP

PROCEDURE:ASPIRATION AND INJECTION UNDER FLUOROSCOPY, RIGHT HIP

DESCRIPTION OF PROCEDURE: Under adequate local anesthesia with 1% Lidocaine, the anterior hip was prepped and an #18 gauge spinal needle was introduced into the hip joint anteriorly.  Aspiration was negative.  Intraarticular position of the needle tip was confirmed with air arthrography.  The hip joint was injected with 8 cc of 0.5% plain Marcaine and 40 mg of Depo-Medrol.  The needle was withdrawn, a dressing was applied, and the patient discharge to be followed in the office. _

Normally I would code this as 20610 & 27093, however the procedure doesn't state the doctor injected dye which would make me think I shouldn't bill the 27093.

I'd appreciate any thoughts on this.

Thanks!

Debbie
Billing Representative
NW Fl Surgery Center


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## dyoungberg (Jan 30, 2013)

*2nd Request-Aspiration & Injection under fluoroscopy*

In an ASC setting Dr performed the following procedure:

POSTPROCEDURE DIAGNOSIS:SYNOVITIS AND DEGENERATIVE ARTHRITIS, RIGHT HIP

PROCEDURE:ASPIRATION AND INJECTION UNDER FLUOROSCOPY, RIGHT HIP

DESCRIPTION OF PROCEDURE: Under adequate local anesthesia with 1% Lidocaine, the anterior hip was prepped and an #18 gauge spinal needle was introduced into the hip joint anteriorly. Aspiration was negative. Intraarticular position of the needle tip was confirmed with air arthrography. The hip joint was injected with 8 cc of 0.5% plain Marcaine and 40 mg of Depo-Medrol. The needle was withdrawn, a dressing was applied, and the patient discharge to be followed in the office. 

Normally I would code this as 20610 & 27093, however the procedure doesn't state the doctor injected dye which would make me think I shouldn't bill the 27093.

I'd appreciate any thoughts on this.

Thanks!

Debbie
Billing Representative
NW Fl Surgery Center


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## dwaldman (Jan 31, 2013)

I would bill

715.35
727.00

20610-RT
77002-TC

Below is from AMA CPT Assistant



June 2012 page 14

Coding Clarification:Hip Arthrography

A frequently asked question (page 11) in the February 2012 CPT Assistant newsletter inadvertently provided misleading instruction related to the reporting of a hip arthrography study. The question referred to a hip arthrogram under fluoroscopy while the answer referred to a hip injection under fluoroscopy, and therefore, the following revised Q&A with additional clarification is provided. 

Question: How is a small injection of contrast into the hip under fluoroscopic guidance reported when performed to confirm needle tip placement prior to the injection of steroids or an anesthetic? 

Answer: When a small amount of contrast is injected into the hip under fluoroscopic guidance to ensure proper needle location before administering an anesthetic or steroid injection, it is appropriate to submit code 77002, Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), to report the fluoroscopic imaging performed. Fluoroscopic guidance is the radiologic technique by which the images are produced. As stated in the descriptor nomenclature, code 77002 is used to describe fluoroscopic guidance for all types of needle placement, such as for biopsy, aspiration, injection, or placement of a localization device. The injection of a steroid or an anesthetic agent into the hip would also be reported using the joint injection code 20610, Arthrocentesis, aspiration and/or injection; major joint or bursa. To further clarify, Hip injection of an anesthetic or steroid under fluoroscopic guidance should not be confused with hip arthrography. When a conventional (radiographic) hip arthrogram is performed, it is reported with an arthrography injection code (code 27093, Injection procedure for hip arthrography; without anesthesia, or code 27095, Injection procedure for hip arthrography; with anesthesia), and the arthrography imaging code 73525, Radiologic examination, hip, arthrography, radiological supervision and interpretation. In this instance, code 77002 is not reported in addition to code 73525 because current imaging practice dictates that fluoroscopy [77002] is considered a component of organ/anatomic-specific radiological supervision and interpretation procedures (ie, 73525). 

The key is not the actual volume of contrast injected, but the intention. If the contrast is injected only to confirm needle position within the joint, the quantity does not matter. If instead the contrast is injected with the intention to outline the joint surface to perform a radiographic arthrogram, then it is an arthrogram even if only a few cc's of contrast material are injected. Again, it is not the volume of contrast but the intention that defines the service. 

Note: The reporting of conventional, computed tomography (CT) and magnetic resonance (MR) imaging arthrography procedures will be featured in an upcoming edition of the CPT Assistant. 

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## michellew (Sep 29, 2014)

*Billing for Lidocaine, bupivacaine, ropivacaine with joint injection under fluoroscop*

Can someone please help me explain why you would/would not bill for Lidocaine, Bupivacaine, or Ropivacaine when it is used with Kenalog for a hip injection under fluoroscopy?  

I cannot seem to find any information to explain this and I want to make sure I am understanding it correctly before I try to explain it.  I am thinking that you would not bill for Lidocaine, Bupivacaine or Ropivacaine when it is used with Kenalog for a hip injection under fluoroscopy because it is used as a local anesthetic for the Kenalog injection.  Is that why it would be considered part of the injection itself?

Thanks for any help you can provide.

Michelle


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## dwaldman (Sep 29, 2014)

The lidocaine or similar drug does not have a specific HCPCS code which makes billing and reimbursement difficult.


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