For Federal payers the correct way to bill bilateral knees (and this comes from the CMS NCCI manual) is to report one line item of 20610-50 with only one unit. You must log in or register to reply here.
What is the qualifying procedure for 20610?
Oct 12, 2010 · when billing Medicare as well as most other payers it is 20610 50 with 1 unit of service and the single code charge. that is if the procedure was performed bilateral, If the procedure was performed say on the right shoulder and right hip then it would be 20610 rt 20610 59 rt if it was performed on the right hip and the left shoulder it would be
Can You Bill 23700 and 20610 together?
You may report multiple units of 20610 only if aspiration/injection is performed in more than one major joint (e.g., both knees or left knee and left shoulder). If aspirations and/or injections occur on opposite, paired joints (e.g., both knees), you may report one unit of 20610 with modifier 50 Bilateral procedure appended, per CMS instruction. Non-Medicare payers may specify different …
Does Medicare pay for code 20610?
Jul 16, 2021 · 20610 bilateral I believe that Medicare, BCBS and Humana require bilateral procedures billed on one line using the -50 modifier and one unit. Be sure to double your fee, though. United generally likes them on separate lines. Hope that helps.
Can You Bill code 20610 twice?
Dec 01, 2018 · Billing the injection procedure. The procedure code (CPT code) 20610 may be billed for the intraarticular injection. The charge, if any, for the drug or biological must be included in the physician’s bill and the cost of the drug or biological must …
How do I bill bilateral knee injections to Medicare?
The CPT code 20611 is for an arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee or subacromial bursa with ultrasound guidance, with permanent recording and reporting). The code is billed twice because this was a bilateral procedure.Feb 17, 2018
How do you bill bilateral arthrocentesis?
20610: Arthrocentesis, aspiration and /or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance, with permanent recording and reporting.May 24, 2019
Is CPT code 20610 a bilateral procedure?
Reporting Multiple Units If aspirations and/or injections occur on opposite, paired joints (e.g., both knees), you may report one unit of 20610 with modifier 50 Bilateral procedure appended, per CMS instruction.Jun 8, 2021
How do I bill for multiple joint injections?
Report a single unit of 20600-20611 for each joint treated, regardless of how many aspirations and/or injections occur in a single joint. You may report multiple units of a single code for aspiration/injection of multiple joints of same size. (e.g., two large joints, left knee and left shoulder).May 30, 2017
How do I bill a CPT code 20610?
One unit for CPT 20610 is used for each site injected or aspirated but if the aspiration and injection is performed on same site, use one unit for both procedures. If the aspiration and injection is performed on two different sites, use one unit of the 20610 CPT code with modifier 59.
Does CPT code 20610 require a modifier?
The appropriate site modifier (RT or LT) must be appended to CPT code 20610 or CPT code 20611 to indicate if the service was performed unilaterally and modifier (-50) must be appended to indicate if the service was performed bilaterally.
Can you bill an e m with 20610?
20610 and same-day E/M Do not report an E/M service with a planned injection service if the patient presents without complications or a new problem. CPT Assistant (March 2012) offers the following example: A patient complained of left knee pain.May 1, 2015
How often can you bill 20610?
Billing the injection procedure If an aspiration and an injection procedure are performed at the same session, bill only one unit for CPT code 20610. When additional substances are concomitantly administered (e.g. cortisone, anesthetics) with viscosupplementation, only one injection service is allowed per knee.
Can CPT code 20610 be billed with 99213?
Per CCI edits, CPT codes 20610-RT and 99213-25 cannot be billed together; however a modifier is allowed with supporting documentation.Mar 6, 2018
What is the difference between CPT 20610 and 20611?
Use 20610 for a major joint or bursa, such as the shoulder, knee, or hip joint, or the subacromial bursa when no ultrasound guidance is used for needle placement. Report 20611 when ultrasonic guidance is used and a permanent recording is made with a report of the procedure.
Can you Bill 20600 twice?
If the insurance requires two lines to be billed for a bilateral service: Bill two line items with CPT code 20600 (arthrocentesis, aspiration and/or injection; small joint or bursa) Append modifier -LT as the primary modifier on one line, and -RT to the other to indicate a bilateral service.Jan 16, 2019
What is the CPT code for steroid injection?
CPT codes 64479 and 64483 are used to report a single level injection performed with image guidance (fluoroscopy or CT). CPT codes 64480 and 64484 represent each additional level respectively and should be reported separately in addition to the primary procedure when applicable.
What is CPT 20610?
CPT® 20610 describes aspiration (removal of fluid) from, or injection into, a major joint (defined as a shoulder, hip, knee, or subacromial bursa), or both aspiration and injection of the same joint. The procedure may be performed for diagnostic analysis and/or to relieve pain and swelling in the joint.
What is the problem code for a hip bursa?
Based on feedback from Healthcare Business Monthly readers, and what we hear on AAPC Member Forums, one such “problem code” is 20610 Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa); without ultrasound guidance.
Does 20610 include anesthesia?
For Medicare payers, 20610 does not include the drug supply (other than local anesthetic) for injection. If the provider paid for the drug, he or she may report the supply separately using the appropriate HCPCS Level II supply code.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
Purified natural hyaluronates have been approved by the FDA for the treatment of symptomatic osteoarthritis of the knee in patients who have failed to respond to simple analgesics or conservative nonpharmacologic therapy.
ICD-10-CM Codes that Support Medical Necessity
Note: Diagnosis codes must be coded to the highest level of specificity.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Title XVIII of the Social Security Act, Section 1833 (e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period..
Article Guidance
This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L35427 Hyaluronan Acid Therapies for Osteoarthritis of the Knee.
ICD-10-CM Codes that Support Medical Necessity
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted.
ICD-10-CM Codes that DO NOT Support Medical Necessity
All those not listed under the “ICD-10 Codes that Support Medical Necessity" section of this article.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
What modifier is used for 20610?
Also, because he performed the procedure on the right shoulder, report this unit of 20610 with the modifier 59 along with the modifier RT. This will help the payer know that your clinician also performed the procedure on a separate joint on the right side.
What is 20610 used for?
You use 20610 ( ( Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) when your clinician performs arthrocentesis and performs an aspiration or injection into a major joint.
How many units of 20610 are required for arthrocentesis?
The rule is to report one unit of 20610 for one site at which your internist has performed the arthrocentesis. However in your scenario, you are right in reporting the procedure with 20610×3 since your clinician has performed the procedure in three different sites. Here’s the key: But you’ll have to report the three units ...
What modifier do you use for bilateral procedures?
If a procedure is not identified by its terminology as a bilateral procedure (or unilateral or bilateral), physicians must report the procedure with modifier “-50.” They report such procedures as a single line item. (NOTE: This differs from the CPT coding guidelines which indicate that bilateral procedures should be billed as two line items.)
What is bilateral procedure?
Bilateral procedures are procedures performed on both sides of the body during the same operative session. Medicare makes payment for bilateral procedures based on lesser of the actual charges or 150 percent of the Medicare Physician Fee Schedule (MPFS) amount when the procedure is authorized as a bilateral procedure.
