Orthopedic Coding Alert

Question: When I administer a finger joint injection (20600) with fluoroscopy, should I use a modifier to justify billing 76003 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) with it, or can I bill both codes together?

Montana Subscriber

Answer: Code 20600* (Arthrocentesis, aspiration and/or injection; small joint or bursa [e.g., fingers, toes]) does not include fluoroscopy, so your carrier should accept both codes without any modifier appended. In addition, the CCI edits do not preclude you from reporting both codes together, so modifier -59 (Distinct procedural service) is not necessary.

However, if the orthopedist uses fluoroscopy equipment that he or she doesn't own (for instance, if your practice uses the hospital's equipment) or if a technician not employed by your practice performs the fluoroscopy, you should append modifier -26 (Professional component) to 76003. The hospital, radiology clinic or independent radiology technician would bill for their portion of the service by submitting 76003-TC (Technical component).

Some payers maintain their own regulations and guidelines for billing these codes together, so check with your carrier before submitting these claims to request their regulations in writing.

You Be the Coder and Reader Questions were reviewed by Heidi Stout, CPC, CCS-P, coding and reimbursement manager at University Orthopaedic Associates in New Brunswick, N.J.