Orthopedic Coding Alert

You Be the Coder:

Failed Cortisone Injection

Published on Tue Feb 01, 2000

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: A patient did not respond to a cortisone injection to remove calcium deposits in the shoulder. Arthroscopic surgery to remove the deposits took place in an outpatient setting under general anesthesia. Because arthroscopic examination revealed the calcium deposits had eroded a hole in the rotator cuff, a decompression was also necessary. Can we bill for all components of the treatment of this patient?

Anonymous Nevada Subscriber

Answer: Susan Callaway-Stradley, CCP, CCS-P, an independent coding consultant and educator in North Augusta, S.C., explains that as long as the injection and surgery were performed on different calendar days, the injection can be billed (20610, injection, major joint or bursashoulder) in addition to the arthroscopic surgery. To bill for the surgery, both procedures should be listed, with the decompressionthe primary onefirst.

List 29826 (arthroscopy, shoulder, surgical, decompression of subacromial space with partial acromioplasty, with or without coracoacromial release) and then list 29822 (arthroscopy shoulder, surgical, debridement, limited). Under Medicares multiple endoscopy rule, says Callaway-Stradley, no modifier is used on the second procedure. Check with your commercial carriers to determine whether they require a -51 modifier on this code.

Note: Remember to use the HCPCS J code that indicates the drug administered, in this case cortisone (J0810, cortisone, up to 50 mg).

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