Wiki 20610 - I need some expert advice

[darlene.dean@scionhealth]

I need some expert advice on coding arthrocentesis and joint injection. A Medicare patient presents with an ear problem and knee pain. The physician addresses the ear problem then decides to drain fluid from the knee and inject it with Kenalog. My question is can he bill for the arthrocentesis and the injection? Both are coded as 20610. Do I use 2 units with a modifier? Do I bill them on separate lines with a modifier? Do I bill for the E/M with a 25 modifier, 20610 only once and the J code? Thanks for your responses.

 

[murphyrrm]

Ear problem w/tx of knee

THE EAR PROBLEM DX IS NOT MEDICAL NECESSARY FOR THE ASPIRATION AND INJECTION IN THE KNEE. I WOULD MAKE SURE I HAVE A DX FOR THE KNEE AND CODE :

(1) EAR DX (2) KNEE DX

LINE (1) CPT E/M -25 DX 1,2
LINE (2) 20600 DX 2
LINE (3) 20600 MOD 59 DX 2
LINE (4) J CODE MOD 59 DX 2

 

[RebeccaWoodward*]

I need some expert advice on coding arthrocentesis and joint injection. A Medicare patient presents with an ear problem and knee pain. The physician addresses the ear problem then decides to drain fluid from the knee and inject it with Kenalog. My question is can he bill for the arthrocentesis and the injection? Both are coded as 20610. Do I use 2 units with a modifier? Do I bill them on separate lines with a modifier? Do I bill for the E/M with a 25 modifier, 20610 only once and the J code? Thanks for your responses.

You can only report 20610 for the arthrocentesis of the knee; this is a procedure. I'm not sure how the ear injection plays into this.

20610=After administering a local anesthetic, the physician inserts a needle through the skin and into a joint or bursa. A fluid sample may be removed from the joint or a fluid may be injected for lavage or drug therapy. The needle is withdrawn and pressure is applied to stop any bleeding

What injection did they provide for the ear or did they? It almost sounds as if you should report an E/M (w/ mod. 25) to address the ear problem, 20610 for the knee and the "J" code for the kenalog which is linked to the knee dx.

 

[mitchellde]

I think the 20610 twice is for the knee, 1 for the arthrocenteses and one for the kenalog injection. However the descriptor is arthrocentenses and/or injection, so if you do both of the same knee,you can only bill one 20610.

 

[Lisa Bledsoe]

I need some expert advice on coding arthrocentesis and joint injection. A Medicare patient presents with an ear problem and knee pain. The physician addresses the ear problem then decides to drain fluid from the knee and inject it with Kenalog. My question is can he bill for the arthrocentesis and the injection? Both are coded as 20610. Do I use 2 units with a modifier? Do I bill them on separate lines with a modifier? Do I bill for the E/M with a 25 modifier, 20610 only once and the J code? Thanks for your responses.

E/M -25 (dx for ear problem), 20610 ONE unit and J3301x however many units used (usually 4) dx 719.06 (knee effusion). As Debra pointed out, the description of 20610 is "arthrocentesis, aspiration and/or injection"