Orthopedic Coding Alert

Question: If a patient has joint injections in her right shoulder and right hip on the same day, should I report 20610-RT, 20610-76-RT?

Minnesota Subscriber

Answer: Many experts consider modifier 59 (Distinct procedural service) to be more appropriate than modifier 76 (Repeat procedure by same physician) in your case.

Indicating procedures at separate anatomic areas (such as shoulder and hip) is one appropriate use of modifier 59, according to CPT. You should append modifier 76, on the other hand, when the surgeon repeats the exact same procedure, such as the rare instance of two medically necessary injections in the right shoulder on the same day.

If modifier 59 is your payer's preference, you should report 20610-RT (Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]; Right side) and 20610-59-RT.

Watch out: Some coders report that their Medicare carriers prefer modifier 76 on a duplicate code, even when the second procedure is on a separate body part. You should append modifier 76 in this case only if the payer instructs you to do so in writing.