Wiki Billing 20550 (or 20551) with 20610

[KStaten]

Hello, Everyone!

As usual, I have a 2-part question and would appreciate your help.

1) When 20550 (or 20550) is being billed with 20610 for two separate body parts, which modifiers would be used?

Example:
tendon sheath injection, left elbow
bursa injection, right knee

2) Also... I have read conflicting information as to whether LT / RT modifiers are applicable for 20550 or 20551. Thoughts?

Thank You in advance!
Kim

 

[Leandra]

Hello, Everyone!

As usual, I have a 2-part question and would appreciate your help.

1) When 20550 (or 20550) is being billed with 20610 for two separate body parts, which modifiers would be used?

Example:
tendon sheath injection, left elbow
bursa injection, right knee

2) Also... I have read conflicting information as to whether LT / RT modifiers are applicable for 20550 or 20551. Thoughts?

Thank You in advance!
Kim

Per Encoder Pro RT/LT are appropriate modifiers with 20550 and 20551. I would also make sure to use each specific ICD 10 code that goes with left elbow and right knee. I've seen so many times where the modifier and dx don't match so the claim line denies.

 

[Orthocoderpgu]

For 20550/20551 being billed with 20610 the modifier you use will depend on the insurance. If the patient has any type of Medicare plan then use -XS. If not, -59. These modifiers communicate to insurance that the injections were performed for separate and unrelated medical conditions. This should be reflected in the diagnosis codes that they are pointed to as well.

diagnosis codes, diagnosis coding

 

[KStaten]

Per Encoder Pro RT/LT are appropriate modifiers with 20550 and 20551. I would also make sure to use each specific ICD 10 code that goes with left elbow and right knee. I've seen so many times where the modifier and dx don't match so the claim line denies.

Thank you, Leandra! I have always thought that LT/RT modifiers were appropriate, also, but have read several articles that state otherwise. I'm glad that you and the Encoder Pro both agree with me.

As for the diagnoses, I recently had a claim deny for an injection to treat "tennis elbow," or lateral epicondylitis. I linked M77.11 with 20550, RT. In training, I was taught that this was the correct CPT code, and the CPT book actually states "For injection for tennis elbow, use 20550." So, either I have misunderstood or the insurance company made an error.

diagnosis codes, diagnosis coding

 

[KStaten]

For 20550/20551 being billed with 20610 the modifier you use will depend on the insurance. If the patient has any type of Medicare plan then use -XS. If not, -59. These modifiers communicate to insurance that the injections were performed for separate and unrelated medical conditions. This should be reflected in the diagnosis codes that they are pointed to as well.

Thank you, Orthocoderpgu! That is very helpful!

diagnosis codes, diagnosis coding

 

[KStaten]

Thank you, Leandra! I have always thought that LT/RT modifiers were appropriate, also, but have read several articles that state otherwise. I'm glad that you and the Encoder Pro both agree with me.

As for the diagnoses, I recently had a claim deny for an injection to treat "tennis elbow," or lateral epicondylitis. I linked M77.11 with 20550, RT. In training, I was taught that this was the correct CPT code, and the CPT book actually states "For injection for tennis elbow, use 20550." So, either I have misunderstood or the insurance company made an error.

Just as a follow-up, I entered the codes in the Scrubber for CMS1500 tool on AAPC's CODER and received this message in regards to the RT modifier paired with 20551:

"Remove modifier. Appending modifier 50 or modifiers RT and LT will not bring additional payment for 20551. The MPFS lists bilateral indicator 0 for 20551, meaning 150 percent payment adjustment for bilateral procedures does not apply."

Hmmmmmmm...

diagnosis codes, diagnosis coding