Wiki 20610 (multiple units and location) and Depo medrol and labs (89051/89060)

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CoderinJax

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Hi all,

I've asked the questions in a few different places on here and thought it would be better if all together to show the true picture. I've read all of the AAPC articles on the subject of 20610, so I'm familiar with when in diff joint etc, but there's some confusion on joint and bursa in same general area. I've also read multiple threads on here and no absolute answer that I can locate.

Have a Dr billing insurance 20610 x 8 and J1040 x 8, as well as 89051 x4 and 89060 x4.

Here's a breakdown of one of the scenarios:
Injection/Asp into RT shoulder w/ 45mg of NDC 00009028003
Injection/Asp into LT shoulder w/ 45mg of NDC 00009028003
Injection/Asp into RT subacromial bursa w/ 45mg of NDC 00009028003
Injection/Asp into LT subacromial bursa w/ 45mg of NDC 00009028003
Injection/Asp into RT hip w/ 45mg of NDC 00009028003
Injection/Asp into LT hip w/ 45mg of NDC 00009028003
Injection/Asp into RT trochanteric bursa w/ 45mg of NDC 00009028003
Injection/Asp into LT trochanteric bursa w/ 45mg of NDC 00009028003
Performs synovial fluid analysis for all areas mentioned with wbc provided and no crystals shown.

Questions:
1) Since bursae and shoulder/hip joints are technically different, does the above look correct? Or are they close enough to the joint that you only get the code (20610) once per joint space? CPT wording makes it look like you can get joint AND bursa, so I want to make sure that's correct.
2) The NDC provided is for J1030, so should it actually be J1030 x9 instead of J1040 x 8?
3) Does 89051 x 4 and 89060 x 4 seem appropriate/accurate if notating wbc's count and no crystals? (E.G. "LT hip: 5000 wbc and no crystals") Is this notation suffice?

Thank you all SO MUCH for any insight.
 
renee dustman said:
I think this article answers your question about 20610.

https://www.aapc.com/blog/33905-aspiration-and-injection-of-major-joint

The key is that the bursa is part of the joint so however many injections and aspirations are conducted to a joint/bursa counts as 1 unit.
Click to expand...

Hey Renee!
Thanks so much for the response. I had read that article by Mr. Verhovshek, which was excellent; I didn't see however it addressed anywhere that reflects what you're saying above (about "The key is that the bursa is part of the joint so however many injections and aspirations are conducted to a joint/bursa counts as 1 unit")
If the Dr. is injecting the LEFT subacromial bursa and LEFT shoulder, you're saying that should be only 1 unit? Those wouldn't be considered 2 separate anatomical areas? This is where I just want to get some solid clarification because the records (and claim billed to the payer) are split out as if they're 2 separate locations.

The CPT description says "Arthrocentesis, aspiration, and/or injection, major joint OR bursa" which makes it sound like separate areas since they're spelled out separately. I'm trying not to read too much into it, I just feel like CPT could've made it cleaner by using "/" in between joint/bursa instead of "or".

Thanks so much for anything else you might be able to provide. (Also, if you can ask AAPC to grandfather-in all of us original "Fellows" that met the original stringent requirements that would be awesome, too. :))
 
Last edited:
Found the answer in the CMS NCCI manual

Okay, I found my answer as to whether an injection into a bursa and joint in the same area (Eg: subacromial bursa and should joint) could be submitted separately. I found in the CMS NCCI Policy Manual, under Chapter IV, page 18 CMS's stance.

It states "For example, if a physician performs arthrocentesis of the shoulder and two bursae of the same shoulder without ultrasonic guidance, only 1 UOS of CPT code 20610 may be reported."

This clarifies exactly what I needed and I know most payers follow NCCI Edits, so that addresses what was needed.
Here's the link in case anyone wanted to read it. :)

https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html
 
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