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Orthopedic Coding Alert

Reader Questions:

Look to Unlisted for Iliac Crest Bone Graft Injection

Question: My surgeon performed an iliac crest bone graft injection for pain (Kenalog, down to bone). He wants to use 20550, but he didn't inject the tendon sheath, so I don't think it's appropriate. Should we report 20610 instead?

Pennsylvania Subscriber Answer: Because CPT does not include a code that describes this type of injection, you should report 20999 (Unlisted procedure, musculoskeletal system, general).

Submit a description of the procedure with your claim, along with a short letter from the surgeon explaining why the patient required the injection.

You are correct in doubting 20550 (Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar "fascia"]) because the surgeon did not inject the tendon sheath.

Code 20610 (Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) is also incorrect for the same reason - the surgeon did not inject a bursa or joint, so you should avoid using this code for these procedures.

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