Wiki Shoulder injections

[djhalverson]

My providers routinely do a glenohumeral injection along with a bicep tendon injection in the same setting. We bill 20610 and 20550/51 and have been reimbursed. I recently had 2 come back that say the bicep injection is incidental to the glenohumeral. (Optum and Aetna Medicare) 20610 is being paid and 20550 being denied. Has anyone else ran into this?

 

[NRaizman]

At the end of the day, an injection into the biceps sheath will communicate to the glenohumeral joint, but one does not inject the glenohumeral joint through the biceps, so they are generally separate and distinct. The biggest question becomes medical necessity and appropriateness. If this is being done routinely, for what diagnosis? If there's not clearly documented pathology to both the GH joint and the biceps tendon sheath, it would be hard to justify.

Because there is an NCCI Edit between 20610 and 20551, the combo would not be reimbursed by Medicare unless performed on the contralateral shoulder. MA plans and private payors may have specific rules about the applicability of a -59 modifier here.
N

 

[djhalverson]

Thank you! Makes sense. Typically, the diagnosis would be glenohumeral arthritis and biceps tendinitis.