Wiki Dx for 20610 to Medicare

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arrana

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We have been debating covered diagnosis codes for 20610, and would appreciate input from others...

We are a community health center and our ortho provider does a lot of shoulder and knee injections of Kenalog (J3301) using diagnosis for the specific joint pain, 719.4x. Medicare has been paying the procedures with these dx codes. Today we found the only Medicare LCD article listing covered diagnoses for 20610. However, the article was addressing specific drugs (hyaluronan or derivative, Synvisc or Synvisc-ONE for intra-articular injection, 1 mg), Kenalog was not mentioned.

Has anyone had trouble with getting paid by Medicare for 20610 using a 719.4x dx? I say that we keep doing what we've been doing since it seems to be working, AND the article addresses only specific drugs...

Thoughts, opinions, experiences???

Thanks!
 
I work in Ortho and that LCD would only apply if your provider is injecting the hyaluronan or derivative. The pain codes are perfectly fine provided there is no other definitive diagnosis for the patient. Hope this helps :)
 
That helps very much. Thanks for confirming what I was feeling in my gut. :D
 
I just had the same scenario as this. I was able to review the medical note and code burstitis of the knee which is where the doctor did the injection along with 719.46. I haven't had the Dr. use a generalized DX before, but I am interested in how Medicare processed your claim. :)
 
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