Wiki 20551 or 20550

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Blackhorse

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Physical Exam

General: The patient is healthy-appearing and of the stated age. Psych: Alert and oriented, no acute distress.
Head: Normocephalic and atraumatic.
Eyes: Anicteric pupils symmetric, extraocular motion intact.
Lungs: No audible wheezing. Symmetric expansion with inspiration.
No DT or DP pulses bilaterally. No popliteal pulses on the left. Patient has significant tenderness of the plantar fascia both medially and laterally. Diffuse redness from her mid leg distally. Foot blanches with elevation. Decreased sensation in a stocking distribution from the mid leg distally to the toes bilaterally. Tenderness to palpation planetary. Redness blanches with elevation. The skin is intact without any rashes or abrasions. The extremity is vascular intact distally. Sensation and motor intact distally. There is no evidence of lymphadenopathy. Date is non-weight bearing in a wheelchair.
Diagnostic Studies None.

Impression

Plantar fasciitis of left foot. Venous insufficiency.
Arterial insufficiency.
Bilateral peripheral neuropathy.

Plan/Recommendation

I discussed the risks, benefits, and alternatives of the cortisone injection for the plantar fasciitis. The patient wished to proceed and understood the risks of tendon rupture, infection, allergic reaction, or possibly ongoing pain. The foot was prepared with alcohol over the lateral side of the plantar heel. Under direct ultrasound visualization and guidance, I placed a 25-gauge needle around the left plantar fascia! origin. I injected 6 mg of betamethasone, 0.5 cc of lidocaine, and 0.5 cc of Marcaine. Images were saved in the patient's digital record. There were no complications and the procedure was well tolerated. Follow-up will be in 4 weeks for reevaluation.


Our doctor uses 20551 but I think the correct injection code should be 20550.

What do you think?
 
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He stated he used the origin as the site of insertion. The real question is if you are going to add 76942.

Peace
@_*
 
Yes, there is 76942 on the claim. I think Plantar Fascia injection should be 20550, doesn't matter if the word "origin" is used. If his documentation states that his injection include both the planta fascia and the area around a calcaneal spur, then 20551 is appropriate per Medicare LCD.

The other issue with this case is that the doctor use ICD-10 M72.2 which matches 20550 per LCD.
 
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20551 is correct

Look at the description of the code:

The physician injects a therapeutic agent into a single tendon sheath, or ligament, aponeurosis such as the plantar fascia in 20550 and into a single ****tendon origin/insertion site in 20551*****. The physician identifies the injection site by palpation or radiographs (reported separately) and marks the injection site. The needle is inserted and the medicine is injected. After withdrawing the needle, the patient is monitored for reactions to the therapeutic agent.

Your doc stated the injection was at the origin of the tendon.
 
20550 or 20551

Doctor's diagnosis is Plantar Fasciitis of left foot. If you use 20551 for the injection, what ICD-10 code you will use on LCD, this is a Medicare patient. Medicare will deny M72.2 with 20551.
 
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In that case, since the RVU is so close between 20550 and 20551, you should go with the CPT code that will work with the correct Dx and get that claim to process. In any event, thanks for the thought process. I appreciate any and all help in the rationales behind coding Dx and procedures.

Peace
@_*
 
We have a provider who is doing non invasive vascular testing at his office. He is paying for a staff member to perform the test and another Dr to come in and read the test results. The Dr reading the test is not an employee but is paid for each test they read.

:)
Thanks in advance
 
Hi,

We have not got payment while we are coding 20551 and 20610 together for medicare insurance. we are coding like 20610-XU and 20551-51.

We get less payment in 20610 and denial in the 20551 CPT code.


20610-XU with M19.011 ICD code.
20551-51 with M79.18 ICD code.

Please provide your suggestions for the above mention.
 
Hi - As I dont know the scope of work (procedure report) this is some 'general' info that comes to my mind. 20551 is a column 2 edit with 20610. Therefore, no mod on 20610. 20551 you possibly could use 59 or X(EPSU) depending on situation. Guessing w/o seeing, I would pull more towards the XS Mod on 20551---and that is only 'strongly' assuming 20551 was to a different site/structure than the 20610. So it all depends on the procedure report.
Could look something like:
20610-RT or LT (assuming hopefully the provider indicated the laterality)
20551-59 (or XS if a different area than the 20610).
I just spent quite a bit of time looking at the NCCI manual and Medicare CCI Policy Manual as I too have a question elsewhere re: a similar PTP edit situation.
In "my" situation, I discovered that through the definition of Mod 59 (and the procedure report I was coding for) I could not bypass the edit w/any modifier and therefore could not charge my Column 2 procedure.
Your situation will all depend on the procedure report and what is documented.

RE: Mod 51, in my experience when I was in billing, we did not use Mod 51 and "IF" it was needed, Medicare appended it. Good luck.
 
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