Wiki Finger Manipulations and injections preformed on the same fingers

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stwilley

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I would like to get some input on how someone else would code this? We are in an ASC.

NAME OF PROCEDURE:
1. Manipulation under anesthesia left index finger MCP joint, CPT code 26340.
2. Manipulation under anesthesia left index finger PIP joint, CPT code 26340.
3. Manipulation under anesthesia left long finger MCP joint, CPT code 26340.
4. Manipulation under anesthesia left long finger PIP joint, CPT code 26340.
5. Manipulation under anesthesia left ring finger MCP joint, CPT code 26340.
6. Manipulation under anesthesia left ring finger PIP joint, CPT code 26340.
7. Manipulation under anesthesia left small finger MCP joint, CPT code 26340.
8. Manipulation under anesthesia left small finger PIP joint, CPT code 26340.
9. Left index finger PIP joint corticosteroid injection, CPT code 20600.
10. Left long finger PIP joint corticosteroid injection, CPT code 20600.
11. Left ring finger PIP joint corticosteroid injection, CPT code 20600.
12. Left small finger PIP joint corticosteroid injection, CPT code 20600.
 
What do you think, how should it be coded?

What was it done for, Dupuytren's? Was the injection first and then the manipulation of cords? Or, was it definitely the joints? For example, the patient had a trauma and now they have a contracture, etc.?
Just a list of procedures from a header is not enough to fully help.
Did you run it through an edit checker? Did they inject for pain management purposes to be able to do the manipulation?
 
amyjph said:
What do you think, how should it be coded?

What was it done for, Dupuytren's? Was the injection first and then the manipulation of cords? Or, was it definitely the joints? For example, the patient had a trauma and now they have a contracture, etc.?
Just a list of procedures from a header is not enough to fully help.
Did you run it through an edit checker? Did they inject for pain management purposes to be able to do the manipulation?
Click to expand...
The patient did have previous trauma. She was treated with an ORIF 3 months ago. Post op 3 months and she has stiffness and decreased range of motion.

I did run it through a 3rd party company we use to help with coding and I was told to only code the 20600, the 26340 is bundled. However when I look at CCI edits for Medicare it states they can both be billed together, with the 26340 as the primary code.
 
Number of things going on here. I am not a facility coder though, this is from a physician billing point of view.
1. Makes no sense to "only code" the 20600. The RVU is much lower for 20600, ASC only billing 20600 would be a flag. The person giving you the advice said it because the 20600 pops up as primary when you run an edit with 26340. Think of it this way though, if you were a payer looking at the claim, wouldn't you think, gee why is this small joint injection being done under anesthesia in an ASC and not the office?
2. MUEs need to be checked for 26340. Trying to do two per finger due to MCP/PIP isn't going to fly most likely. 4 may be all you get.
3. Just because NCCI edits say, "they can both be billed together" doesn't mean they should. The rationale for the edit between the code pair is standards of medical surgical practice. Meaning, you would need to look up what that means to decide whether to unbundle something. It's not just the P2P edit, but the manual as well.
4. There may be some reason from an ASC perspective that I do not have knowledge on.
5. Depends on the payer you are billing and how the practice follows or doesn't follow edits. If coding from AMA CPT might be a different answer.
 
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