Orthopedic Coding Alert

Question: Can we bill an office visit along with a supartz injection for patients on every visit? For example, when the patient reports for her first supartz injection, we bill 99213, 20610, and J7317 with a diagnosis of 715.16 (Osteoarthrosis, localized, primary; lower leg). Can we bill these codes together the remaining four consecutive shots, which we perform weekly?

Michigan Subscriber

Answer: Because your practice sees the patient solely to administer the injection, it is rare that circumstances would warrant reporting an E/M code in addition to the injection code at each visit. Most practices would not be able to justify billing the E/M each week.

In most circumstances, therefore, you should only report codes 20610 (Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) and J7317 (Sodium hyaluronate, per 20 to 25 mg dose for intra-articular injection), and nothing else.

Of course, your office may experience rare exceptions to this rule.

For example, if the patient presents to your practice for an initial evaluation and the surgeon decides to inject the Supartz that day, you should report both the injection and the E/M code (such as 99203, Office or other outpatient visit for the evaluation and management of a new patient...).

In that case, you should append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code to show your insurer that the E/M visit included more than a simple pre-injection assessment.

As is always the case when you use a modifier, you should ensure that your physician's documentation demonstrates the separate nature of the services.