Melissa Posted Fri 18th of November, 2016 13:26:55 PM
Hello, the physician says he did a Left Hip injection with separate arthrogram and SI joint injection. Would I code this:
27096-LT and 20610-LT-59
SuperCoder Answered Mon 21st of November, 2016 07:17:37 AM
CPT code 27096-LT is a correct code for SI joint injection.
In second scenario CPT 27093 is the injection code just for an arthogram (diagnostic) and code 20610 is therapuetic. Current CCI edits list 20610 as a Column 2 code of 27093, which means you shouldn't normally report both procedures together if the physician performs the arthrogram and injection on the same hip. The bundle does allow you to report a modifier, however, to differentiate between services in some instances. Check your documentation to determine whether a modifier such as 59 (Distinct procedural service) might be justified. If you can't report both 20610 and 27093 for the encounter, submit only 27093. Thank you.
Melissa Posted Mon 21st of November, 2016 11:42:00 AM
Thank you. I am still a little confused: see his dictation below:
"Left hip joint was identified and need tip placed in the left joint capsule and .75 cc of contract was injected to ensure proper placement, then 3 cc of solution was deposited in hip joint; Again fluoroscopy, and the left SI joint was identified and Xylocaine injected; tip of the 22 gauge spinal needle was inserted in joint space, 05 cc of contrast was used and the remaining treatment solution was injected without difficulty."
He wants to code 27096 LT, 20610 LT...should it actually be 27093 LT and 27096 LT? Thank you so much!
SuperCoder Answered Tue 22nd of November, 2016 01:12:55 AM
When a small amount of contrast is injected into the hip under fluoroscopic guidance to ensure proper needle location before administering an anesthetic or steroid injection, it is appropriate to submit code 77002, Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), to report the fluoroscopic imaging performed. Fluoroscopic guidance is the radiologic technique by which the images are produced. As stated in the descriptor nomenclature, code 77002 is used to describe fluoroscopic guidance for all types of needle placement, such as for biopsy, aspiration, injection, or placement of a localization device. The injection of a steroid or an anesthetic agent into the hip would also be reported using the joint injection code 20610, Arthrocentesis, aspiration and/or injection; major joint or bursa. To further clarify, Hip injection of an anesthetic or steroid under fluoroscopic guidance should not be confused with hip arthrography. When a conventional (radiographic) hip arthrogram is performed, it is reported with an arthrography injection code (code 27093, Injection procedure for hip arthrography; without anesthesia, or code 27095, Injection procedure for hip arthrography; with anesthesia), and the arthrography imaging code 73525, Radiologic examination, hip, arthrography, radiological supervision and interpretation. In this instance, code 77002 is not reported in addition to code 73525 because current imaging practice dictates that fluoroscopy  is considered a component of organ/anatomic-specific radiological supervision and interpretation procedures (ie, 73525).
The key is not the actual volume of contrast injected, but the intention. If the contrast is injected only to confirm needle position within the joint, the quantity does not matter. If instead the contrast is injected with the intention to outline the joint surface to perform a radiographic arthrogram, then it is an arthrogram even if only a few cc's of contrast material are injected. Again, it is not the volume of contrast but the intention that defines the service.
In short it will be correct to bill 27093 LT and 27096 LT only, if documentation does not justify 20610 as a separate procedure.