Wiki 20610 performed unilaterally with a bilateral diagnosis code

[jkottarathil]

Hi,

I have come across the situation a few times where the provider has diagnosed a patient with bilateral OA of the knees (M17.0). During a visit, they performed a joint injection into only one of the knees. In this scenario, would you report a bilateral diagnosis code since they have diagnosed bilateral OA? Or would you report only the unilateral diagnosis code (ex: M17.11) since that is what the procedure was performed on?

If it helps, payer is Medicare part B and practice is in MN.

 

[whatwouldyousay]

there’s no reason to exclude the condition on one side just because that side isn’t being treated at encounter. The condition exists bilaterally and if it’s documented that way on the visit that’s the best code to submit with the procedure.

 

[Orthocoderpgu]

Code 20610 is an injection procedure, not an E/M. As coders our job is to make sure that the documentation supports the code/s being billed. When you inject one joint, only the diagnosis for that joint should be mapped to it. Otherwise your telling the insurance that you injected the right knee but are treating the left knee, which is not the case. The bilateral diagnosis code can go on the E/M if supported, but both codes do not go on the injection if your only treating one of them.

 

[amyjph]

Short of looking up anything "official", I can see it both ways. It makes more sense to only report the single side that is being treated if it is an injection-only visit. I have seen denials/rejections for laterality conflict because of this. Even with TKA where let's say, they have (B) OA but they are getting a RT TKA and the (B) ICD-10 was reported instead of the RT. I have also seen where it is no problem at all. I agree, if it was the E/M it would be more likely versus for a single side injection-only.

 

[dineshkumar.p7@accesshealthcare.com]

Hi,

I have come across the situation a few times where the provider has diagnosed a patient with bilateral OA of the knees (M17.0). During a visit, they performed a joint injection into only one of the knees. In this scenario, would you report a bilateral diagnosis code since they have diagnosed bilateral OA? Or would you report only the unilateral diagnosis code (ex: M17.11) since that is what the procedure was performed on?

If it helps, payer is Medicare part B and practice is in MN.

Yes we can code M17.0, if procedure 20610 performed in unilateral side. No need to change bilateral dx(M17.0) to unilateral diagnosis(M17.11 or M17.12). Medicare needs only procedure 20610 with anatomical modifiers(RT or LT or 50) to get a payment.

 

[OGGPPL]

Hi, we have the same issue with Ortho doctor. He diagnosed few patients few M17.0 Bilateral Primary Osteoarthritis of Knee and gave 20610 injections in both knees. We billed 20610 with 50 mod & dx code as M17.11 Unilateral primary osteoarthritis, right knee & M17.12 Unilateral primary osteoarthritis, left knee and are being denied by Medicaid Managed care plans as dx codes are not specific. Can someone please advice here as to where am I going wrong here as I have all of these claims being denied for dx code with M series and i cannot think of anything specific codes as pt seen for bilateral knee pain and got diagnosed as Arthritis of Knee. Any inside here will be a big help please. Thank you.

 

[whatwouldyousay]

Hi, we have the same issue with Ortho doctor. He diagnosed few patients few M17.0 Bilateral Primary Osteoarthritis of Knee and gave 20610 injections in both knees. We billed 20610 with 50 mod & dx code as M17.11 Unilateral primary osteoarthritis, right knee & M17.12 Unilateral primary osteoarthritis, left knee and are being denied by Medicaid Managed care plans as dx codes are not specific. Can someone please advice here as to where am I going wrong here as I have all of these claims being denied for dx code with M series and i cannot think of anything specific codes as pt seen for bilateral knee pain and got diagnosed as Arthritis of Knee. Any inside here will be a big help please. Thank you.

If the injection is treating the pain and not the arthritis maybe they way a pain code as primary dx? I’m referring to chapter 6 guidelines for pain.

 

[OGGPPL]

If the injection is treating the pain and not the arthritis maybe they way a pain code as primary dx? I’m referring to chapter 6 guidelines for pain.

This makes sense. I will try to bill on couple of this with pain dx code and watch if those get paid. Thank you for your suggestion and I will update if this works. Thank you.

 

[kdlberg]

Medicare gets picky about modifiers, and I know there's some codes where they want it coded with -LT and -RT instead of -50. No, it doesn't make sense to me either. But I've been doing this long enough where I just accept the oddities.