# 20610 anterior and posterior



## cunnjp (Aug 18, 2010)

Our doc is injecting 1 shoulder (or major joint) but indicating on the superbill that there were multiple anterior & posterior sticks.  Thus, he wants to bill 20610 twice (for the anterior and posterior).  Has anyone seen this?

JC


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## Bella Cullen (Aug 18, 2010)

cunnjp said:


> Our doc is injecting 1 shoulder (or major joint) but indicating on the superbill that there were multiple anterior & posterior sticks.  Thus, he wants to bill 20610 twice (for the anterior and posterior).  Has anyone seen this?
> 
> JC



No I've never seen that but for 20610 it says aspiration and/or injection (singular not plural) so it seems like you would be able to bill twice for it if doc did inject into two joints.


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## kjstearns (Aug 18, 2010)

Here's what I was able to find....hopefully it will help.

Subject Ask Margie: Aspiration and injection in same joint 
Source Coder Pink Sheets: Orthopedic 
Publication Orthopedic: Orthopedic Coder's Pink Sheet, May 2010, Vol. 11, No. 5 
Effective Date May 3, 2010 
Publish Date May 3, 2010 


Question: Can I report 20610 twice in the same joint - once for aspiration and once for injection?

Answer: No, you can't. I am starting to see this error coming up in audits more and more for some reason. The CPT descriptor for 20610 reads: "Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., shoulder, hip, knee joint, subacromial bursa)." The term "and/or" in the description tells you the code "includes the performance of one or all of the procedures described in the same major joint or bursa," CPT explains. "Therefore, code 20610 should only be reported one time when both aspiration and injection are performed in the same major joint or bursa" (CPT Assistant, March 2001).

Similarly, for knee or hip injections, at least, you also may not report multiple units of 20610 for multiple injections into the same joint.

A few years ago, I asked members of the American Academy of Orthopaedic Surgeons' (AAOS) Coding Committee about separate reporting of injection codes to the shoulder during the same treatment session (e.g., 20610 to the glenohumeral joint and 20605 to the acromioclavicular joint). In general, they agreed that separate billing could be warranted if separate needles were used. In the shoulder, the AC and GH joints are separated by the joint capsule. By contrast, in the knee, once the solution is injected it will cover the medial, lateral and patellofemoral compartments.


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## lisamilo (Aug 18, 2010)

*20610 posterior/anterior*

I agree with the previous information.  This almost sounds like your doctor wants to bill for 20552. trigger point injections, which is not appropriate. 20610 x1 per joint is the correct way to go.
Lisa M Sacramento CA


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## Bella Cullen (Aug 19, 2010)

That information says one time in the same joint. 
So if doc did injections in more than one joint then you should be able to bill for it more than once. 
But I guess for this case you cannot because it wasn't two specific joints.


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## Bella Cullen (Aug 19, 2010)

That information says one time in the same joint. 
So if doc did injections in more than one joint then you should be able to bill for it more than once. 
But I guess for this instance you cannot because it is not two specific joints.


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## kimmak (Sep 22, 2010)

I would check with the Provider and see if they are injecting into any ligaments or tendons around the joint, but no matter which part(s)  of the joint they are injecting, it is still only one joint.  Our Providers usually inject the joint and if needed, any ligaments or tendons contributing to the problem.


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