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shoulder injections -20610 billed twice?

Mike Posted Thu 13th of October, 2016 21:21:36 PM
Can code 20610 be billed twice for injections of a left shoulder Glenohumeral acromioclavicular injection with a subacromial bursa injection?
SuperCoder Answered Fri 14th of October, 2016 02:00:45 AM

Greetings from SuperCoder!

 

Medically Unlikely Edit (MUE) for this code is 4, which means you can report this 4 times for the same patient, on the same DOS (date of service) but please make sure that the procedures should be performed on different sites. 

 

If the physician has performed the two injection procedures on the different sites of the left shoulder, you will report two units of 20610 and append modifier LT to both codes and modifier 59 (Distinct procedural service) to the code in second line along with the modifier LT. This will inform the payer that your provider also performed the procedure on a separate site on the left shoulder. In case you do not use modifier 59, it will be considered as duplicate by the payer's system/software and the claim will be denied.

 

Please feel free to write if you have any further questions.

 

Thanks.

SuperCoder Answered Mon 17th of October, 2016 04:31:14 AM

Greetings!

 

Our editors did further research on this topic and we have a small correction for you, please find below the updated answer. 

 

We apologise for any inconvenience caused, and we appreciate your understanding as we continue to improve our customer experience.

 

As per 2016 NCCI Manual excerpt regarding Medicare's stance on reporting joint injections, CPT codes 20600-20611 are a family of codes describing arthrocentesis, aspiration, and/or injection of different sized joints or bursae with or without ultrasound guidance. The unit of service (UOS) for each of these codes is a joint and its surrounding bursae, if any. A physician should not report more than one (1) UOS for arthrocentesis of any one joint regardless of whether or not the physician also aspirates or injects one or more of its surrounding bursae. For example, if a physician performs arthrocentesis of the shoulder and two bursae of the same shoulder without ultrasound guidance, only 1 UOS of CPT code 20610 may be reported.

As per this information, Glenohumeral acromioclavicular and subacromial bursa come under the same major joint (i.e. shoulder joint). It means both injections are performed on the same major joint. So you cannot report code 20610 more than once in this case.

 

We hope this helps you.

 

Best Regards

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