Anesthesia Coding Alert

Question: What modifiers should I report for a visit that includes a right shoulder injection, a left knee injection, and a left elbow injection?


Arkansas Subscriber
Answer: Report each injection on a separate line: the shoulder and knee injections each with 20610 (Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) and the elbow injection with 20605 (... intermediate joint or bursa [e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa]).

Whether you append modifiers depends on your carrier's preference. Some commercial carriers require modifier 51 (Multiple procedures) or 59 (Distinct procedural service) for these multi-injection encounters. You would not report either modifier for a Medicare patient because modifier 59 only applies to procedures with bundling issues, and Medicare assigns modifier 51 at its discretion.

Because the physician performed two injections that qualify for 20610, some coders ask if you should append modifier 76 (Repeat procedure by same physician) to the second injection. The answer to this is no: Modifier 76 implies the physician repeats the same procedure in the same area. Because your physician injected the patient's shoulder and knee, modifier 76 is not appropriate.