Wiki Ultrasound-guided injections

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andreasuemoore@hotmail.com

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A new provider to us comes with sports medicine experience and is qualified to do these injections. I am asking for information or resource information regarding 76942, how to code these, required documentation, and payable diagnoses. Is this used in conjunction with, say 20610 for example, or instead of? Thanks for any pointers in the right direction.
 
If he's doing joint injections with U/S guidance there are 3 new codes effective 1/1/15, 20604 (small joint), 20606 (intermediate joint) and 20611 (large joint). These are all joint injections with ultrasound guidance, with permanent recording and reporting. Your best bet for payable diagnoses and coverage is to contact your insurance companies or go on-line to look up their policies.
 
CPT book states SI joint injection is 27096. It states if CT or Fluoroscopy is not performed, use 20552, with 20552 you can bill 76942 for the ultrasound guidance
 
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Yes, I've seen this, try and explain that to an attorney in a Pennsylvania hearing. 20552description reads "trigger point" injection. The physician states "I performed a joint injection not a muscle injection". While I see the description in the book it is hard to defend to a non coder and attorney "why" this is the appropriate way of doing things. I was also looking at 20611 "injection of major joint" with ultrasound.
 
reds8163 said:
Yes, I've seen this, try and explain that to an attorney in a Pennsylvania hearing. 20552description reads "trigger point" injection. The physician states "I performed a joint injection not a muscle injection". While I see the description in the book it is hard to defend to a non coder and attorney "why" this is the appropriate way of doing things. I was also looking at 20611 "injection of major joint" with ultrasound.
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The reasoning for using 20552 when guidance isn't done for the SI joint injection, is that without guidance, you can't guarantee that you're actually in the targeted joint space. I know, hard to argue that point! There is a statement in the CPT book with the 27096 regarding this, to help back you up, and I believe CPT Assistant from the AMA also has an article or Q&A, but you have to subscribe to get access to it.

HTH some!
 
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