Health Information Management

Report additional services separately for a knee effusion procedure

APCs Insider, November 10, 2005

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

Report additional services separately for a knee effusion procedure

QUESTION: A patient comes to the ED with knee effusion. The ED physician aspirates the joint (20610) and gives the patient a shot of demerol and phenergan (90782) and rocephin (90788). The final diagnosis is "knee effusion".

Is it appropriate to code all three services? When analgesia is required (i.e., fracture reductions), it seems really obvious. But I am confused as to whether I should report additional services for these lesser procedures.

ANSWER: In this scenario, bill the joint aspiration (20610) and the rocephin injection (90788). We assume also that the ED visit contains the proper documentation to support a separate ED visit code (99281-99285) appended with modifier -25.

The only service which may or may not be separately billable is the demerol and phenergan injection. Since this is likely a general pain control injection-and not sedation analgesia-you can separately code and bill it as 90782. If the injection is for sedation analgesia, bill it as 99141 rather than 90782.



Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular