Wiki What is the acceptable code to bill for major Joint Injections

[kehinde]

Hello,

Carefirst Bcbs is rejecting Cpt code 20610 for billing major joint injection. They are saying it's not approved for reimbursement as an Ambulatory surgery center procedure.

Do anyone has any suggestion as to any other cpt codes that can be used to bill for major joint injections.


Thanks.

 

[dclark7]

According to the medicare fee schedule 20610 has an ASC indicator of P3 which means that the code was added to the ASC list in 2008 or later. Here is a link to the fee schedule http://www.cms.gov/apps/ama/license.asp?file=/ascpayment/downloads/April-2012-ASC-addenda.zip

Of course Carefirst may have their own rules, but the code is apporved by Medicare for payment in an ASC, it pays a little over $38.

 

[kehinde]

Thank you so much for your response. But the code (20610) has a "P3" payment indicator which indicate "office based procedure". This therefore means it can only be reimburse if done in an office setting and not in a surgery center. I'm billing for outpatient surgery center and all the claims that was billed with this code together with fluoroscope was rejected by Bcbs . I'm confused now as to the acceptable code that can be used to code for major joint injections.

 

[mitchellde]

20610 is the only code for a major joint injection. If it is not ASC approved then it should be performed in the location for which it is approved, which according to your research is an office setting.
However according to the link provided the definition of P3 is:

P3 Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs.

So it was office based , was added to the ASC list and is paid based on nonfacility RVUs.
However as stated this is Medicare and BC can see this differently.

 

[kehinde]

Thank you for all your suggestion. I will use this info! to let the management know that this code is only payable if the procedure is done in an office setting.

 

[psacco]

Check your P3 again...being a code for a trigger point injections, hte P3 might be an Anethesia physical status modifier, which some BCBS do not like.