Wiki Denials on 20610

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nneecole44

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Is anyone getting denials on 20610? (This was to Aetna/Coventry Medicare). I billed a 20610 RT and J3301 x 4 with dx M70.61. The denial was 1952 ( No valid LCD). I go to check the LCD for 20610 and it is gone. I can't find the LCD for 20600 or 20605 either. I am so confused. I looked up the CCI edits and the 20610 is still in there and doesn't mention any changes besides adding the imagining codes. I thought the 20610 could be used for bursitis, effusion and osteoarthritis? Regardless of what medication you injected. I then went to the LCD for 20552 and 20553 and bursitis is on there. I am at a loss. Thank you for any help.
Necole
 
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20610 describes aspiration (removal of fluid) from, or injection into, a major joint (defined as a shoulder, hip, knee, or subacromial bursa), or both aspiration and injection of the same joint. The procedure may be performed for diagnostic analysis and/or to relieve pain and swelling in the joint.
If you google hip joint, you find out that it consists of the femoral head and the acetabulum. Trochanter of the femur is located outside of this joint. Trochanter bursa covers the bony point of the hip bone called the greater trochanter. Inflammation of this bursa is called trochanteric bursitis. That's why we should use trigger point injection -20552 or 20553
 
You just blew my mind. I just took a CEU class last September that told us the complete opposite. I can still use the 20610 for osteoarthritis of the hip, knee and shoulder with Kenalog or Depo Medrol? Just making sure.
 
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LCD for 20610

We're getting denials for 20610 stating that the diagnosis is not appropriate based on LCD. I go to the LCD and am confused. How do I search for covered diagnoses? Am I overlooking something?
 
I have just starting receiving these denials as well from Novitas Medicare (Pennsylvania) and they too have directed me to the LCD - but what I found was that the J-code wasn't there to support the administration code 20610. I was billing J0702 & J3304-Zilretta.
I am hoping that since Medicare's update in May it's just an error....Anyone?
 
Barbs63 said:
I have just starting receiving these denials as well from Novitas Medicare (Pennsylvania) and they too have directed me to the LCD - but what I found was that the J-code wasn't there to support the administration code 20610. I was billing J0702 & J3304-Zilretta.
I am hoping that since Medicare's update in May it's just an error....Anyone?
Click to expand...
I'm hoping so as well. We have patients that come for gel injections and they are supplied by their specialty pharmacy so we can only bill the 20610 since they have purchased the medication.
 
I also received a denial for medical necessity. Doctor injected Kenalog 40mg to treat localized edema of right knee. We used J3301 with 20610 with ICD-10 M25.561 and R60.0. Can anyone help me?
 
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