Orthopedic Coding Alert

Answer: An injection into the hip is coded 20610 (arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) regardless of whether it is performed under anesthesia. If the physician had difficulty performing the procedure and could validate through his or her documentation an increased work level of approximately 30 to 50 percent, you might consider submitting the documentation with a -22 modifier (unusual procedural services) and ask for additional reimbursement. Just because the procedure is performed under anesthesia, does not usually justify the increase an insurance carrier is looking for a significant increase in the physicians actual work effort. The fluoroscopy (76000, fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) is considered bundled, so it is not billable separately.