# Steroid injection during SX for PO pain billable?



## LynnS.321 (Aug 27, 2009)

Hello:
Is a steroid injection performed during knee surgery billable for post operative pain by orthpedic surgeon?
Thanks so much in advance.
Lynn, CPC


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## mbort (Aug 27, 2009)

no per the AAOS and NCCI:

AAOS #1 of the 'included' list:
1. local infiltration of medication(s), anesthetic or contrast agent before, during, or at the conclusion of the operation 

NCCI 
Introduction
"The National Correct Coding Initiative Policy Manual for Medicare Services and the edits were developed for the purpose of encouraging consistent and correct coding and reducing inappropriate payment. 


The edits and policies do not include all possible combinations of correct coding edits or types of unbundling that exist. Providers are obligated to code correctly even if edits do not exist to prevent use of an inappropriate code combination."


Chapter One NCCI:
"Examples of services integral to a large number of procedures include: 
- Local, topical or regional anesthesia administered by the physician performing the procedure
The global surgical package includes the administration of fluids and drugs during the operative procedure.

Also info on modifier 59 being a different site/location - you are not supporting.

CPT Assistant
Dec 2007 CPT Assistant
Question: If a surgical arthroscopy of the knee is performed (29870-29889) and after withdrawal of the scope and portal suture the surgeon injects bupivacaine for postoperative pain management directly into the knee joint, may code 20610 be reported in addition to the CPT code for the specific arthroscopic procedure performed?

Answer : Code 20610, Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa), should not be reported when performed concurrent with another intra-articular procedure (eg, knee arthroscopy). However, should the bupivacaine injection be performed at an anatomic site other than that of the knee arthroscopy, then the appropriate code from the 20600-20610 series should be reported, as appropriate, with modifier 59, Distinct procedural service, appended.


Claims Processing 100-04 Chapter 12 Section 40:
Components of a Global Surgical Package
Intra-operative Services - Intra-operative services that are normally a usual and necessary part of a surgical procedure;

Postsurgical Pain Management - By the surgeon;

Not all edits are listed in the CCI tables


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## LynnS.321 (Aug 27, 2009)

Thank you.  That is what I was thinking also.


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