Wiki joint injection/aspiration w/ ultrasound same knee bundling issues

[maljdcpc]

not sure how to code ultrasound in this situation:

aspiration of ganglion/synovial cyst back of rt knee with ultrasound guidance
and cortisone injection in rt knee for pain, O/A (no ultrasound)

question: would I be able to bill the ultrasound guidance for the ganglion/synovial cyst aspiration? if so, what modifier would need to be applied?

ex:
-99204, 25 (dx: 719.46, 715.96, 727.51)
-20610, RT (dx: 719.46, 715.96)
-J1040 (dx: 719.46, 715.96)
-20550, 59, RT (dx: 727.51)
-76942 (dx: 727.51)

thank you.

 

[mitchellde]

You would not use the 20550 for what you have documented as to what was done. The provider aspirated the knee and injected the same knee you would bill only the 20611 for the aspiration/injection using ultrasound. There is no way to bill for both an aspiration and injection in the same knee and the 20611 covers the ultrasound.
You are trying to connect the tendon injection to the synovial cyst code, which will not work and the injection was not for the cyst it was for the pain. You have tried to connect the pain in knee and the OA code to the joint injection.
If the injection was for pain you would use the appropriate 338 code for the pain but the provider must document acute or chronic. You would not use a 719.46 with the 715.36.
If the provider does not state degenerative or primary OA you cannot code 715.96. You would code the 338.-- with the 715.36.
If you have a note that clearly states a tendon injection was performed then I will change my answer.

 

[maljdcpc]

thank you for your help on this...
ok-just so i'm clear- dr aspirated 43cc of serous fluid removed from lateral gastroc muscle-would that that be bundled in the 20611 then? so take out the 20550?

 

[mitchellde]

Without the procedure note to guide me yes that is correct based on the information you have provided. Bill only the 20611 and the J code. If the office visit meets the criteria of significant and separate then bill it also with a 25 modifier. If no tendon injection us documented, take out the 20550 and the ultrasound is included so drop it as well.