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Family Practice Coding Alert

Increase Revenue Ethically by Reporting Same-day Joint Injections and E/M Services

The typical treatment for conditions like tendinitis, osteoarthritis, rheumatoid arthritis or other joint maladies includes joint injections (20600-20610). As straightforward as the injections seem, this service raises questions among many family practice coders. They often debate whether an evaluation and management (E/M) service may be charged in addition to the injection, and if the drug administered may also be reported. Plus, coders are often stumped about how to code multiple injections either to different joints or to the same joint on opposing sides of the body.

Not surprisingly, the answer to these questions depends on the situation. Coders may not report an E/M code, for instance, if the patient visits the office for the sole purpose of receiving the joint injection. Other patient visits, however, allow the E/M code to be assigned also. Likewise, some drugs may be reported with HCPCS Level II codes but others may not be.

Reporting E/M Services With Joint Injections

Whether an E/M code may be reported in addition to the joint injection depends on several factors. The most clear-cut of these are situations where E/M services are never reported with the injection code: on those rare occasions when the patient is seen only for a preplanned injection. Some patients may require a series of injections. Although the initial evaluation of the injury may justify both an E/M and injection code (see specific circumstances described below), followup treatments would be reported only with the injection code.

Beyond this circumstance, however, the issue becomes more complex and correct coding may depend on whether the E/M services are related to the reason the injection was given.

Both an E/M code and the joint injection code may be reported if a patient is seen for a condition or illness that is unrelated to the diagnosis that ultimately requires the injection, according to Randy Thompson, CPC, coding specialist with HMI, a consulting firm based in Nashville that specializes in Part A and Part B billing.

For instance, he says, a physician may see a 45-year-old woman suffering from an upper respiratory infection (URI). During the exam, the patient also mentions she has pain and stiffness in her left shoulder. The family physician diagnoses osteoarthritis (715.11) and gives an injection of cortisone (J0810) into the joint to reduce the inflammation. Because the woman presented with symptoms of an URI and there was no predetermined plan to provide an injection, coders would assign the appropriate level of outpatient E/M service (i.e., 99213, for an established patient) and 20610* (arthrocentesis, aspiration and/or injection; major joint or bursa [e.g. shoulder, hip, knee joint, subacromial bursa).

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