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Denials on 20610

Is anyone getting denials on 20610? (This was to Aetna/Coventry Medicare). I billed a 20610 RT and J3301 x 4 with dx M70.61. The denial was 1952 ( No valid LCD). I go to check the LCD for 20610 and it is gone. I can’t find the LCD for 20600 or 20605 either. I am so confused. I looked up the CCI edits and the 20610 is still in there and doesn’t mention any changes besides adding the imagining codes. Have I been billing the hip and knee injections all wrong? I thought the 20610 could be used for bursitis, effusion and osteoarthritis? Regardless of what you medication injected. I then went to the LCD for 20552 and 20553 and bursitis is on there. I am at a loss. Thank you for any help.
Necole

Medical Billing and Coding Forum

20610 DX Issue

I might be overthinking this, but I can’t wrap my brain around it to save my life. Our guidelines are crystal clear that if we have a definitive diagnosis, we are NOT to code any symptoms that are considered to be associated with the definitive diagnosis.

My issue: Payers are denying the 20610 when we use anything other than a pain diagnosis.

Example: pt has right rotator cuff tear and provider decides to give them an injection to alleviate the pain

My thoughts: the rotator cuff tear is the correct dx, but it will not pass through the edits based on the dx being inappropriate for the procedure.

Can anyone please tell me how they are handling this?

Medical Billing and Coding Forum

20610 (multiple units and location) and Depo medrol and labs (89051/89060)

Hi all,

I’ve asked the questions in a few different places on here and thought it would be better if all together to show the true picture. I’ve read all of the AAPC articles on the subject of 20610, so I’m familiar with when in diff joint etc, but there’s some confusion on joint and bursa in same general area. I’ve also read multiple threads on here and no absolute answer that I can locate.

Have a Dr billing insurance 20610 x 8 and J1040 x 8, as well as 89051 x4 and 89060 x4.

Here’s a breakdown of one of the scenarios:
Injection/Asp into RT shoulder w/ 45mg of NDC 00009028003
Injection/Asp into LT shoulder w/ 45mg of NDC 00009028003
Injection/Asp into RT subacromial bursa w/ 45mg of NDC 00009028003
Injection/Asp into LT subacromial bursa w/ 45mg of NDC 00009028003
Injection/Asp into RT hip w/ 45mg of NDC 00009028003
Injection/Asp into LT hip w/ 45mg of NDC 00009028003
Injection/Asp into RT trochanteric bursa w/ 45mg of NDC 00009028003
Injection/Asp into LT trochanteric bursa w/ 45mg of NDC 00009028003
Performs synovial fluid analysis for all areas mentioned with wbc provided and no crystals shown.

Questions:
1) Since bursae and shoulder/hip joints are technically different, does the above look correct? Or are they close enough to the joint that you only get the code (20610) once per joint space? CPT wording makes it look like you can get joint AND bursa, so I want to make sure that’s correct.
2) The NDC provided is for J1030, so should it actually be J1030 x9 instead of J1040 x 8?
3) Does 89051 x 4 and 89060 x 4 seem appropriate/accurate if notating wbc’s count and no crystals? (E.G. "LT hip: 5000 wbc and no crystals") Is this notation suffice?

Thank you all SO MUCH for any insight.

Medical Billing and Coding Forum

20610 multiple joint denial

We have been getting denials from Anthem when billing 20610 on multiple joints at one visit. We have several different scenarios…bilateral knees with Rt shoulder, bilateral shoulder with Rt hip, etc. We have billed them as 20610-50 (linked to the bilateral joint dx codes) and 20610-XS-Rt (linked to Rt dx code). They have come back denying the single 20610, but paying the bilateral. When our follow-up girl has spoken to an Anthem rep, she was told that they won’t pay the 20610-XS-Rt, because they already paid for a 20610-Rt in the 20610-50.
We then tried rebilling as corrected claim as 20610-Rt 2 units (linked to the 2 different Rt dx) and 20610-Lt (linked to the Lt dx). They have still come back denied.
Our follow-up girl is asking if we can simply bill 20610 3 units linked to all dx, with no anatomical modifier. She said they keep telling her they want it on one line. I’m so confused. Has anyone else run into this problem? How do you suggest we bill these? Is there a problem with using XS modifier with Anthem??

Please help!

Medical Billing and Coding Forum

Humana is denying my cpt 20610

We bill 20610 all the time to Humana and Medicare with many different Dx codes but all of a sudden Humana is denying then when billed with dx M67.811 and all the other codes in that dx family. I have checked the CMs website and there isn’t a LCD code listing for this cpt. Can any one help me?? Have called Humana but I find whenever I call them it is a waste of my time and don’t get clear information that makes any sense.

Medical Billing and Coding Forum