Primary Care Coding Alert

Code 20610 might always need a modifier for Medicare pay If denials for trigger point and joint injections are plaguing you, sticking to these guidelines will put your injections coding back on the payment track. From California to New Jersey, injection coding dilemmas abound. "What modifier should I use for multiple muscle injections into both knees?" asks Nazila Mogtader with Northside Medical Billing Inc. in San Ramon, Calif. Another reader reports National Government Services (NGS), the Part B carrier for New Jersey, has recently begun denying injection code 20610, stating "required modifier is missing or inconsistent with modifier used." Avoid these hitches with these tips. Report 1 TPI Code Based on Muscle(s) Injected CPT 2004 revised TPI codes 20552-20553 to have physicians report the codes one time per session, regardless of the number of injections given. The documentation should include the injections- location, number of injections, and muscles involved. Here's how to assign the codes: 1. Use 20552 when the physician injects one or two muscles. 2. When the physician injects three or more muscles, you should report 20553 without units or modifiers. The location of the muscles does not matter. Example: A runner complains of bilateral knee pain (719.46, Pain in joint; lower leg). The FP injects the popliteus muscles in the back of the right and left knees. In this case, report one unit of 20552. Error averted: You would not use a modifier, such as modifier 50 (Bilateral procedure), to indicate the injection was on each side of the body. Codes 20552 and 20553 are not eligible for bilateral reporting, according to the 2008 Medicare Physician Fee Schedule. Look at Joint Size to Select 20600-20610 You-ll choose the correct arthrocentesis code (20600-20610, Arthrocentesis, aspiration and/or injection -) based on the joint size. Use the following table as your guide: Indicate Body Side(s) to Process 20610 Claim Joint injection codes, unlike TPI, are per injection. Therefore, units and modifiers can come into play. The Medicare Physician Fee Schedule does allow bilateral reporting with 20600-20610. With knee injections (20610, Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]), you might always have to indicate whether the physician performed the injection on the right (RT) side, left (LT) side, or on both knees (bilaterally, modifier 50). NGS "has an article regarding injection of hyaluronan that requires reporting either of the following modifiers (RT, LT, or 50) with the code 20610," points out Marvel J. Hammer RN, CPC, CCS-P, PCS, ACS-PM, CHCO, president of MJH Consulting in Denver. NGS issued a local coverage determination covering 24 states. The policy, which applies to injections of hyaluronans, a molecule recently used in the management of osteoarthritis of [...]