Neurology & Pain Management Coding Alert

Question: Our physician recently treated a patient in our office with olecranon bursitis in her right and left elbows. To treat the patient, he injected 10 mg of Depo-Medrol into each joint. Should I report this as 20605 twice with modifier 59 attached to the second code?

Kansas Subscriber

Answer: You are right to report 20605 (Arthrocentesis, aspiration and/or injection; intermediate joint or bursa [e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa]) for the injection procedures. You should leave modifier 59 (Distinct procedural service) off this claim, however, and choose another modifier instead.

Here's why: Modifier 59's description specifically states, "When another already established modifier is appropriate it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used."

Because your provider performed the injection procedures on mirror image or bilateral locations, you should report the injections as bilateral procedures rather than separate and distinct procedures, with one of these coding tactics:

Option 1: Many payers, including most Medicare carriers, request bilateral procedures with modifier 50 (Bilateral procedure) and one unit of service. For those payers, report 20605 as one line item with modifier 50 and one unit of service.

Option 2: Other payers require that you append modifiers LT (Left side) and RT (Right side) instead when you report bilateral procedures. For these payers, report 20605-LT and 20605-RT as separate line items with one unit of service each.

Remember: Regardless of your modifier choice, link 726.33 (Olecranon bursitis) to 20605 each time you report it to support medical necessity for the injections. Also, if your practice supplies the medication, include J1020 (Injection, methylprednisolone acetate, 20 mg) on the claim for the total amount of steroid injected.