Wiki Depo Medrol injections

[munderwood]

I've got a patient that had a joint injection in one shoulder but two injections in the other shoulder. How would this be coded? The person that usually codes these injections is out and we are trying to fill in. The injection was 40 mg of depomedrol. Would it be 20610-50 and j1030-50 or does it matter how many injections just once on each side?

Thanks,
Melody

 

[jkayser]

Hello, here is a link regarding the billing of multiple injections into same shoulder joint:

http://intervalvular4.rssing.com/chan-3699660/all_p78.html

11/29/12 SuperCoder

"The CPT descriptor for 20610 reads: ?Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., shoulder, hip, knee joint, subacromial bursa).? The term ?and/or? in the description tells you the code ?includes the performance of one or all of the procedures described in the same major joint or bursa,? CPT explains. ?Therefore, code 20610 should only be reported one time when both aspiration and injection are performed in the same major joint or bursa? (CPT Assistant, March 2001).Similarly, for knee or hip injections, at least, you also may not report multiple units of 20610 for multiple injections into the same joint. American Academy of Orthopaedic Surgeons? (AAOS) Coding Committee comments about separate reporting of injection codes to the shoulder during the same treatment session (e.g., 20610 to the glenohumeral joint and 20605 to the acromioclavicular joint). In general, they agreed that separate billing could be warranted if separate needles were used. In the shoulder, the AC and GH joints are separated by the joint capsule. By contrast, in the knee, once the solution is injected it will cover the medial, lateral and patellofemoral compartments."

Unless the requirements above are met, 20610 should only be billed 1x per joint.

The drug code cannot be billed with modifier 50. It should be billed on one line with the appropriate total units. One unit would be 40 mg for J1030. J1040 is for 80 mg. The HCPCS book lists the specific drug names associated with each of these codes.

I hope this information is helpful.

Jean Kayser CPC CIRCC

 

[munderwood]

Depo Medrol Injections

Thanks for the info I really appreciate it. On the 20610 if it is rt and lt you could bill with rt, lt or 50 depending on the payor correct? In that case on the medicine code, could you list it twice since the modifier would be on the injection code? I use to code these several years ago and I havn't had to up until now and I know things change all the time. I never coded the medicine though because I worked for a radiologist and we just billed for the interpretation of the charges. Did you mean on the medicine that regardless of whether right or left you would list once and say like if it was 40mg on each side you would use that j1030 and bill as 2 units? Thanks for your response I really appreciate your help.

Thanks again,
Melody

 

[jkayser]

Hello, yes, you may check with the payer regarding how they prefer bilateral services to be billed. You may also ask the payer about the drug charge. Billing the drug charge twice, as you suggest, would not be correct and would most likely result in a duplicate denial on the second drug charge.

Here is a link to a prior forum discussion with info on billing the drug charge. The author of this reply was Arlene J. Smith CPC COBGC.

https://www.aapc.com/memberarea/forums/showthread.php?t=62708

"Check the NDC number on the packaging for the Depo Medrol they are using. That number matches up to the doseage...if the number cooresponds to a 40mg dose then use J1030 code with 2 units. If the NDC is the same regardless of the dosage then you could use J1040 with 1 unit. You do need to be sure that the NDC matches up to what you are actually billing out."
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Here is a Supercoder link on the same subject:

http://www.supercoder.com/coding-ne...he-coder-stick-to-injection-specifics-article

"you should also change how you reported the Depo-Medrol (J1030, Injection, methylpred-nisolone acetate, 40 mg). Most carriers want J1030 billed in units. So rather than listing J1030 twice, you should report J1030 x 2."

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I hope this helps!

Jean Kayser CPC CIRCC