You might need multiple modifiers to make fluoroscopy/injection claim fly.
Coding for arthroscopic injections can become a maze of confusion quickly if you don’t sort out the details before you start; you have to check for codeable procedures that the physician might perform for each injection.
If you want to squeeze every ounce of reimbursement out of these injection claims, check out this real-world case study from a coder in Nevada:
“Our physician recently performed multiple arthroscopic injections. The documentation indicates that she performed two separate injections: one on the patient’s left finger and one on the right elbow.
“The notes also state that the physician used fluoroscopic guidance for both injections. The only arthroscopic injection codes I see that specify guidance are for ultrasounds. How do I code for intra-articular injections with fluoroscopic guidance?”
Do this: On the claim, you should report 20605 (Arthrocentesis, aspiration and/or injection, intermediate joint or bursa [e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa]; without ultrasound guidance) for the elbow injection with modifier RT (Right side) appended, if the payer requires RT/LT modifiers. Then, report 20600 (… small joint or bursa [e.g., fingers, toes]; without ultrasound guidance) for the finger injection with modifier LT (Left side) appended, if the payer requires it.
Finally, report 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) times two for the guidance. Ensuring that the documentation clearly shows that the injection sites were two separate locations is important, as this will prove that reporting the fluoroscopy code twice was correct coding.
One more thing: You may also want to check with your payer to see if it wants modifier XS (Separate structure) or modifier 59 (Distinct procedural service) appended to the fluoroscopy codes to better illustrate this point.